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S152 COMPARISON OF FULL-DOSE INTRAVESICAL BCG VERSUS HALF DOSE BCG AND MITOMYCIN-C IN TREATMENT OF PATIENTS WITH SUPERFICIAL BLADDER CANCER
Results: Transurethral endoscopic ureterectomy was successfully performed in 21 of all 24 cases without any intraoperative complications or urinary extravasation into the perivesical tissues. 3 patients (12,5%) required conversion to standart open ureterectomy because of ureteral stripping failure, due to previous ureteral and abdominal surgeries. The mean operative time was 163±61 minutes, the mean duration of urethral catheterization was 5 days and the mean hospital stay was 9 days. For a mean follow-up period of 30 months, 2 patients with stage pT3 tumor developed visceral metastases and died at 7 and 11 months, respectively. No intravesical or locoregional tumor recurrences were observed during the follow-up period. Conclusions: The stripping technique for transurethral endoscopic ureterectomy during nephroureterectomy is minimally invasive and safe surgical procedure in the treatment of upper urinary tract transitional cell carcinoma.
S149
Hydronephrosis is an independent predictor of lymph node involvement in muscle-invasive bladder transitional cell carcinoma
Abbasi M.A.1, Kamali K.1, Akhlaghkhah M.1, Farokhi-Khajeh-Pasha Y.2, Abbasi A.2 1 Iran University of Medical Science, Dept. of Urology, Tehran, Iran, 2Tehran University of Medical Science, Dept. of Urology, Tehran, Iran Introduction & Objectives: Hydronephrosis a common finding in patients with bladder carcinoma that rates from 7.2% to 54.1%, might be considered as an important factor in staging of bladder tumors. This study focused to explore the prognostic effect of hydronephrosis prior to radical cystectomy in muscle invasive Transitional Cell Carcinoma (TCC) of the bladder. Material & Methods: During 6-years, a consecutive of 164 patients (138 male and 26 female) with TCC of the bladder, who were underwent radical cystectomy, were included in this retrospective study. None of the patients had distant metastatic disease at the time of cystectomy.Hydronephrosis ,defined as dilatation of the renal pelvis and calyces with or without secondary changes of the renal parenchyma or renal function, was confirmed by radiographic imaging. Histological grading was performed according to the method of Bergkvist. Tumor staging and grading were conducted in accordance with TNM and WHO classifications (grade I to III), respectively. Results: Hydronephrosis was detected in 86 of 164 patients (52%), of whom 76 (88.3%) had unilateral hydronephrosis (left kidney in 40; right kidney in 36 patients) and 10 patients (11.7%) presented with bilateral hydronephrosis. The mean±SD age was 63.9±11.1 years (range 63 to 85). Patients with hydronephrosis were more likely to have extravesical disease at the time of radical cystectomy compared with patients without hydronephrosis (P=0.03). In multivariate analysis hydronephrosis was correlated with higher tumor stage, orifice and lymph node involvement. Preoperative hydronephrosis was significantly associated with higher T stage (P = 0.001) and Lymph node involvement (p<0.0001). Conclusions: hydronephrosis at the time of diagnosis of bladder cancer is an important and independent prognostic variable of advanced tumors. hydronephrosis might be considered as an indicator of lymph node involvement in muscle invasive TCC of the bladder treated with radical cystectomy.
S150
Elevation of il8, il6, il5 and il4 in urine samples of patients with high grade bladder cancer
Milosevic R.1, Vojvodic D.2, Cerovic S.3, Milovic N.1, Aleksic P.1, Campara Z.1, Bancevic V.1, Jovanovic M.1, Kosevic B.1, Nikolic I.1, Teodorovic G.1, Spasic A.1, Simic D.1, Stanojevic I.2, Magic Z.2, Majstorovic I.2 1 Militay Medical Academy, Dept. of Urology, Belgrade, Serbia, 2Militay Medical Academy, Institute For Medical Research, Belgrade, Serbia, 3Militay Medical Academy, Institute For Pathology, Belgrade, Serbia Introduction & Objectives: The precise staging of bladder tumors represents the clinical base in treatment planning and prognosis of the illnes. High prevalence of bladder carcinoma together with reccurence tendency represent important medical problem in spite of successful early treatment procedures. Local tumor growth as well as metastatic potential is critically dependent of microenvironmental growth factor production. The mixture of cytokines that is produced in the tumour microenvironment has an important role in cancer pathogenesis. Cytokines are secreted or membrane-bound proteins that regulatethe growth, differentiation and activation of immunecells. The cellular alterations that give rise to cancer provoke changes in local cytokine expression. These perturbations stimulate immune-cell infiltrates, which, in turn, release additional cytokines that act in an autocrine or paracrine fashion. Efforts to understand cytokine function during tumour development and progression are complicated by the pleiotropy and apparent redundancy of cytokine action and by the ways in which the overall cytokine environment shapes the effects of individual cytokines. On the other side, local specific antitumor immune response represents most important factor that influence tumor growth and spreading and finally disease outcome. The aims of our investigations were to: investigate urine cytokine levels in patients with TCC correlating them to clinical and pathological signs of tumor advances and to find out is it possible for urine cytokine levels to determine prognosis and final outcome of the illnes.
Material & Methods: Naturally, micturated urine samples were obtained from 45 patients with newly diagnosed bladder cancer. Patients were divided according to cytological, radiological and patohistological findings in group with superfitial (G2, pT1) or infiltrative TCC (G3-G4, pT2-pT3). Concentration of cytokines (IL1b, TNFa, IFNg, IL2, IL4, IL5, IL6, IL8, IL10 and IL12) was estimated with commercial flowcytometric test kit. Results: The highest levels of IL2 and IFNg were in samples of patients with G3 TCC. Conversely, IL12 concentrations were highest in samples of G4 TCC patients, highly statistically differing between G2/G3 and G2/G4 patient groups. Levels of IL8, IL6 and IL4 were significantly higher in samples of G3 TCC patients comparing to G2 TCC group. The trend of TH2 cytokine elevation that follows tumor progression is continued in G4 TCC samples, showing the highest levels of IL8, IL6 and IL5 in our investigation, making the significant difference for these cytokines between G4/G2 groups. Conclusions: Results of our investigations indicate local significant IL8, IL6, IL4 and IL5 increment that follows tumor progression in patient with TCC.Urine concentration of IL8 above 3000 and IL5 above 1000 seems to be very bad prognostic factors and are predictors for rapid illnes progresion.
S151
Bladder cancer after managing upper urinary tract transitional cell carcinoma: Risk factors and survival
Milojevic B.1, Djokic M.1, Sipetic-Grujicic S.2, Vuksanovic A.1, Milenkovic-Petronic D.1, Dragicevic D.1, Nikic P.1, Nale D.1 1 Clinical Center of Serbia, Clinic of Urology, Belgrade, Serbia, 2Medical School, University of Belgrade, Depatment of Epidemiology, Belgrade, Serbia Introduction & Objectives: To identify independent risk factors for developing subsequent bladder cancer after surgical management of upper urinary tract transitional cell carcinoma (UUT-TCC). To define whether the development of bladder cancer has influence on the survival of patients who underwent surgical management of UUT-TCC. Material & Methods: This study included 92 patients treated surgically for UUTTCC. 31 patients with a previous history of bladder cancer, 28 patients with concomitant blader cancer and 3 patients who died in the first 6 months after surgery were excluded. The median follow-up after surgery was 39.5 months (range, 6 to 112 months). To identify the factors associated with the development of subsequent bladder cancer after surgical management of UUT univariate and multivariate analyses using the logistic regression model were performed. The intravesical disease-free rate and survival were calculated by the Kaplan-Meier method, and the log-rank test was used for the statistical differences. Results: Of the 92 patients, 20 (21.7%) patients treated for UUT-TCC developed subsequent bladder tumours, at a mean (range) interval of 16.3 (3-84) months. Out of 20 patients, 17 (85%) developed subsequent bladder tumours less than 2 years after their UUT tumour has been removed. In a multivariate analysis, tumour multifocality was the only independent predictor associated with the development of subsequent bladder cancer (P=0.028) with a risk ratio (RR) of 3.52 (95%CI=1.14210.848). Intravesical recurrence-free survival rates for these 92 patients at 1, 3, 5 and 7 years were 85.8%, 80%, 79.3%, 78.3%, respectively. Patients with tumours extending to multiple sites were significantly more likely to undergo subsequent intravesical recurrence compared with those with tumours located at a single site (P=0.006, Log Rank). Development of bladder cancer has no significant effect on survival of patients who underwent surgical management of UUT-TCC, compared with patients without bladder cancer development (P=0.117). Conclusions: The multiplicity of the tumour of the uper urothelium is independent risk factor for the occurence of urinal bladder cancer. The occurence of the urinal bladder tumour after the surgical extirpation of the primary tumour does not have an impact on the survival of the patients.
S152
Comparison of full-dose intravesical BCG versus half dose BCG and Mitomycin-C in treatment of patients with superficial bladder cancer
Yari H.1, Fallahnezhad M.2, Haji Karim B.3, Tavasoli Shirvan S.2 1 Ayatollah Mosavi Hospital, Zanjan University of Medical Science, Dept. of Urology, Zanjan, Iran, 2Razi Science Researchers Institute, Dept. of Researches, Tehran, Iran, 3Vali-E-Asr Hospital, Zanjan University of Medical Science, Dept. of Infectious Diseases, Zanjan, Iran Introduction & Objectives: Respecting to this fact that recurrence is a wellknown complication of standard treatment of superficial bladder cancers, this study aimed to compare long term results of full dose intravesical BCG versus half dose intravesical BCG combined with Mitomycin-C in patients with superficial bladder cancer who were admitted in Shahid- Modarres hospital-Tehran from March 2005 to March 2008. Material & Methods: This is a clinical trial which conducted on 60 cases of confirmed superficial bladder cancers. Patients randomized into two groups. In group A, patients received intravesical BCG 120 mg/week for 6 weeks and group B patients received 20 mg Mitomycin-C and 60 mg BCG weekly for 6 weeks, intravesically. Treatment results evaluated as recurrence rate in a follow-up period
Eur Urol Suppl 2010;9(6):595
of at least 21 months, and complications including fever, dysuria and frequency and generalized symptoms (e.g. malaise) in short time follow-up period assessed. Results: 8 cases interrupted the trial for different reasons. In group A, fever was occurred in 28.6% of cases, dysuria in 60.7% of cases, frequency in 71.4% and generalized symptoms in 32.1% of cases. In group B patients, these problems observed in 11.1%, 40.7%, 44.4% and 11.1% of cases, respectively. Tumor recurrence rate in group A was 32.1% and it was 11.1% in group B patients (p< 0.07). Conclusions: Intravesical instillation of half-dose BCG combined with half-dose Mitomycin-C seems to be more effective than intravesical administration of fulldose BCG. Further studies in this field are recommended.
S153
Extended pelvic lymphadenectomy at the time of radical cystectomy for muscle-invasive bladder cancer
Smilov N.1, Halachev N.1, Lozev I.2, Lozev P.1 1 Medical Institute Ministery of Interiors, Dept. of Urology, Sofia, Bulgaria, 2Medical Institute Ministery of Interiors, Dept. of Surgery, Sofia, Bulgaria Introduction & Objectives: We assess retrospectively the results of extended pelvic lymphadenectomy in the treatement of muscle-invasive bladder cancer for staging of the disease and the frequency of perioperative complications. Material & Methods: From January 2006 to June 2010, 35 radical cystectomys with extended pelvic lymph node dissections, were completed for muscle–invasive (T3a min) and recidive low-differentiated localized (T2 G3) bladder cancer. The extended pelvic lymphadenectomy included the removal of lymph nodes between the genitofemoral nerve; the external iliac vessels and the obturator fossa (with dissection of the nodes around the obturator nerve and behind the iliac vessels), in medial direction extending to the bladder fascia. The distal border of dissection is the deep iliac circumflex artery with the Cloquet node in the femoral canal ; and includes in the proximal direction the removal of the paraaortal, paracaval and presacral lymph nodes reaching the level of inferior mesenteric artery. We analyse the number of the positive nodes in the different groups; the operative time lengthening related with the dissections, the type and the frequency of the dissection-related complications. Results: There is a total number of 612 lymph nodes removed (an average 19 per patient (ranging from 11 to 34); positive for methastatic invasion are 61 (9.7%) lymph nodes. Positive to nodal methastic involvement are 12 patients, as follows in each stage- T2 – 1 patient; in T3 – 8 patients; in T4 – 3 patients. The specific lymph node groups involvement is : the obturator group – 24.5%; external iliac-19.7%; internal iliac – 13.1%; common iliac -11.5%; paravesical 9.8%; paracaval 8.2%; paraaortal 8.2%; presacral 4.9% The operative time for the lymphadenectomy is approximately 90 min., with complementary extension reaching 60 min, in case of preceding radiation therapy, extraordinarily obese patient or other anatomic peculiaritys. There are no intraoperative complications (like injuries of major blood vessels, nerves or viscera) There is no case of intraoperative mortality.We have accepted as dissection-related complications: lymphorrhea lastng over 2 weeks in 6 patients; temporary lymphoedema in lower limbs – in 2 patients; lymphocele -1 patient; pulmonary embolism – in 1 patient. Conclusions: At present, there is no standard concent for the limits of the lymphadenectomy at the time of surgery for muscle–invasive bladder cancer. The retrospective analysis of our data helps us to claim that the extended lymph node dissection with proximal border the inferior mesenteric artery take the chance for better staging and potential improvement in survival of the patients, at the cost of acceptable length of the surgical time, and type and frequency of complications comparable with the conventional lymphadenectomy.
S154
Superficial bladder cancer and overexpression of p53
Lepara Z.1, Junuzović D.1, Bajramović S.1, Lepara O.2 1 Clinical Centre University of Sarajevo, Dept. of Urology, Sarajevo, Bosnia and Herzegovina, 2Medical Faculty, Institute of Physiology, Sarajevo, Bosnia and Herzegovina Introduction & Objectives: Superficial bladder cancer usually presents challenge and treatment dilemma for the urologist. Evaluation of p53 overexpression can helps us to determine early progression and recidivism of these tumors. Material & Methods: We have done open prospective study of 243 patients both male and female age ranged from 49-78 years with diagnosed transitional cell carcinoma (TCC) of bladder after initial TURBT. Additionally p53 overexpression was assessed by immunohistochemistry (IHC). The pathological stage and IHC score were assigned by one pathologist. We have focused our study to pT1 grade 2 TCC of bladder and correlation to p53 overexpression. Patients were divided into two groups with positive p53. Group (A)-less than 20% of tumor’s cells positive to p53 and group (B)-more than 20% tumor’s cells positive to p53. Patients with multilocular tumor and tumor greater than 3 cm were excluded. Follow up was regularly done by urine cytology and cystoscopy after 3 months regularly for the first year. For comparisons and correlation of the parameters we used chi-square test, Pearson’s index, Fischer’s and Wilcoxon test and multivariate analysis (p<0,05).
Eur Urol Suppl 2010;9(6):596
Results: Thirty six patients were diagnosed with pT1 grade 2, all less than 3 cm and unilocular tumor and positive p53. In group A we had 20 patients who had recidivism of the disease after 9 months into the same grade. In group B we had 16 patients who had recidivism after first 3 months follow up and eight of them had progression into pT2 TCC of bladder (p<0,05). Conclusions: Immunohistochemistry approved presence of p53 of tumor’s cell of TCC of bladder is in corellation with early and rapid recidivism and progression of disease.
S155
The coping and help seeking behaviours for management of urinary incontinence problem
Bilgic D.1, Kızılkaya Beji N.1, Ozbas A.2, Cavdar I.2, Aslan E.1, Yalcın O.1 1 Istanbul University Florence Nightingale College of Nursing, Dept. of Obstetric and Gynecologic Nursing, Istanbul, Turkey, 2Istanbul University Florence Nightingale College of Nursing, Dept. of Surgical Nursing, Istanbul, Turkey Introduction & Objectives: This study was designed to determine the coping styles of individuals with urinary incontinence problem and their help seeking behaviours. Material & Methods: The study was conducted at Istanbul Medical Faculty Urogynecology and Urology Outpatient Clinic between January and June 2010. The study sample consisted of 130 women and 50 men who were diagnosed with urinary incontinence; and who were willing to participate in this study. The data were collected in an interview using a questionnaire covering 29 questions. Data analysis was performed using SPSS software. Results: The women’s mean age was 48±10, the men’s mean age was 67.5±9.7. More than half of the women (55.4%) had continuous urinary incontinence and 57.7% of them were too much bothered with this problem. The duration of urinary incontinence in women was 8±7 years, in men was 2.3±2 years. One third of men (31.4%) had continuous urinary incontinence and 41.2% of men were too much bothered with this problem. More than half of women (55.8%) reported that the first time they experienced urinary incontinence, they ignored it, hid it and preferred not to mention about it to anybody. It was determined that 50.4% of women did not seek help for urinary incontinence. Most women (60%) sought medical advice 1-5 years later following occurrence of initial urinary incontinence, 14.6% of them went to a physician in following 6-10 years. Nearly one third of the men (29.4%) expressed that for first when they experienced the urinary incontinence problem, they kept this problem secret and did not share it with anybody. More than half of men (52.9%) sought medical advice for the management of urinary incontinence problem. Forty eight percent of men consulted a physician 1-3 months after the urinary incontinence occurred. Coping behaviours of both groups for management of the urinary incontinence symptoms were: keeping feet warm, performing hot application to perineum, going frequently to toilet despite the lack of sense of urgency to urinate, having a bath more often than usually, reducing the amount of daily drinking water, using pad, cloth pads etc., changing underwear/carrying spare clothes, cleansing using hot water, looking for foreground toilet in unknown places, preferring to go to the places especially with toilet, and preferring clothes which are taken off easily, wearing long pants/tights etc., restricting the physical activity, restraining from the social life, and praying etc. Conclusions: While women mostly do not prefer to seek medical advice for urinary incontinence problem, men tend to go to the doctors more often than women. Except for treatment seeking behaviours, both men and women are practicing coping methods for the management of urinary incontinence such as going frequently to toilet, keeping feet warm, hot application to perineum etc.
S156
Comparison of cystoscopy with diffusionweighted magnetic resonance images used in the diagnosis and follow-up of patients with bladder tumor
Ceylan K.1, Taken K.1, Geçit I.1, Pirinççi N.1, Güneş M.2, Karaman M.1 1 YYU Faculty of Medicine, Dept. of Urology, Van, Turkey, 2Van Dİvan Hayat Hospital, Dept. of Urology, Van, Turkey Introduction & Objectives: To compare diffusion-weighted magnetic resonance imaging (DW-MRI) with cystoscopy in the diagnosis and follow-up of patients with bladder tumor and to investigate histopathological correlation. Material & Methods: A total number of 59 patients, between 31-85 years (mean age 60 ± 13.03) who referred to our clinic due to a hematuria complaint were enrolled into the study. Patients were evaluated by USG for an upper urinary system pathology and then DW-MRI (average 7 days) and cystoscopy were conducted. Apparent diffusion coefficient (ADC) of images was calculated from the tissues and bladder masses that belong to a normal bladder mucosa. Results: A mass was determined in 43 patients out of 59 (n= 34 malign, n=9 benign) patients with DW-MRI by the means of cystoscopy while no any masses were determined in 16 of the patients. Regarding ADC values, mean ADC values of 34 patients who were diagnosed with a bladder tumor (1,05 ± 0.22 x 10־³mm²/s), was significantly lower than the mean ADC values obtained from the normal bladder wall (1,830 ± 0.18 x 10־³mm²/s) whereas a statistically significant difference was found (p<0.001). ADC values in 9 patients with a benign lesion
S149
Hydronephrosis is an independent predictor of lymph node involvement in muscle-invasive bladder transitional cell carcinoma
Abbasi M.A.1, Kamali K.1, Akhlaghkhah M.1, Farokhi-Khajeh-Pasha Y.2, Abbasi A.2 1 Iran University of Medical Science, Dept. of Urology, Tehran, Iran, 2Tehran University of Medical Science, Dept. of Urology, Tehran, Iran Introduction & Objectives: Hydronephrosis a common finding in patients with bladder carcinoma that rates from 7.2% to 54.1%, might be considered as an important factor in staging of bladder tumors. This study focused to explore the prognostic effect of hydronephrosis prior to radical cystectomy in muscle invasive Transitional Cell Carcinoma (TCC) of the bladder. Material & Methods: During 6-years, a consecutive of 164 patients (138 male and 26 female) with TCC of the bladder, who were underwent radical cystectomy, were included in this retrospective study. None of the patients had distant metastatic disease at the time of cystectomy.Hydronephrosis ,defined as dilatation of the renal pelvis and calyces with or without secondary changes of the renal parenchyma or renal function, was confirmed by radiographic imaging. Histological grading was performed according to the method of Bergkvist. Tumor staging and grading were conducted in accordance with TNM and WHO classifications (grade I to III), respectively. Results: Hydronephrosis was detected in 86 of 164 patients (52%), of whom 76 (88.3%) had unilateral hydronephrosis (left kidney in 40; right kidney in 36 patients) and 10 patients (11.7%) presented with bilateral hydronephrosis. The mean±SD age was 63.9±11.1 years (range 63 to 85). Patients with hydronephrosis were more likely to have extravesical disease at the time of radical cystectomy compared with patients without hydronephrosis (P=0.03). In multivariate analysis hydronephrosis was correlated with higher tumor stage, orifice and lymph node involvement. Preoperative hydronephrosis was significantly associated with higher T stage (P = 0.001) and Lymph node involvement (p<0.0001). Conclusions: hydronephrosis at the time of diagnosis of bladder cancer is an important and independent prognostic variable of advanced tumors. hydronephrosis might be considered as an indicator of lymph node involvement in muscle invasive TCC of the bladder treated with radical cystectomy.
S150
Elevation of il8, il6, il5 and il4 in urine samples of patients with high grade bladder cancer
Milosevic R.1, Vojvodic D.2, Cerovic S.3, Milovic N.1, Aleksic P.1, Campara Z.1, Bancevic V.1, Jovanovic M.1, Kosevic B.1, Nikolic I.1, Teodorovic G.1, Spasic A.1, Simic D.1, Stanojevic I.2, Magic Z.2, Majstorovic I.2 1 Militay Medical Academy, Dept. of Urology, Belgrade, Serbia, 2Militay Medical Academy, Institute For Medical Research, Belgrade, Serbia, 3Militay Medical Academy, Institute For Pathology, Belgrade, Serbia Introduction & Objectives: The precise staging of bladder tumors represents the clinical base in treatment planning and prognosis of the illnes. High prevalence of bladder carcinoma together with reccurence tendency represent important medical problem in spite of successful early treatment procedures. Local tumor growth as well as metastatic potential is critically dependent of microenvironmental growth factor production. The mixture of cytokines that is produced in the tumour microenvironment has an important role in cancer pathogenesis. Cytokines are secreted or membrane-bound proteins that regulatethe growth, differentiation and activation of immunecells. The cellular alterations that give rise to cancer provoke changes in local cytokine expression. These perturbations stimulate immune-cell infiltrates, which, in turn, release additional cytokines that act in an autocrine or paracrine fashion. Efforts to understand cytokine function during tumour development and progression are complicated by the pleiotropy and apparent redundancy of cytokine action and by the ways in which the overall cytokine environment shapes the effects of individual cytokines. On the other side, local specific antitumor immune response represents most important factor that influence tumor growth and spreading and finally disease outcome. The aims of our investigations were to: investigate urine cytokine levels in patients with TCC correlating them to clinical and pathological signs of tumor advances and to find out is it possible for urine cytokine levels to determine prognosis and final outcome of the illnes.
Material & Methods: Naturally, micturated urine samples were obtained from 45 patients with newly diagnosed bladder cancer. Patients were divided according to cytological, radiological and patohistological findings in group with superfitial (G2, pT1) or infiltrative TCC (G3-G4, pT2-pT3). Concentration of cytokines (IL1b, TNFa, IFNg, IL2, IL4, IL5, IL6, IL8, IL10 and IL12) was estimated with commercial flowcytometric test kit. Results: The highest levels of IL2 and IFNg were in samples of patients with G3 TCC. Conversely, IL12 concentrations were highest in samples of G4 TCC patients, highly statistically differing between G2/G3 and G2/G4 patient groups. Levels of IL8, IL6 and IL4 were significantly higher in samples of G3 TCC patients comparing to G2 TCC group. The trend of TH2 cytokine elevation that follows tumor progression is continued in G4 TCC samples, showing the highest levels of IL8, IL6 and IL5 in our investigation, making the significant difference for these cytokines between G4/G2 groups. Conclusions: Results of our investigations indicate local significant IL8, IL6, IL4 and IL5 increment that follows tumor progression in patient with TCC.Urine concentration of IL8 above 3000 and IL5 above 1000 seems to be very bad prognostic factors and are predictors for rapid illnes progresion.
S151
Bladder cancer after managing upper urinary tract transitional cell carcinoma: Risk factors and survival
Milojevic B.1, Djokic M.1, Sipetic-Grujicic S.2, Vuksanovic A.1, Milenkovic-Petronic D.1, Dragicevic D.1, Nikic P.1, Nale D.1 1 Clinical Center of Serbia, Clinic of Urology, Belgrade, Serbia, 2Medical School, University of Belgrade, Depatment of Epidemiology, Belgrade, Serbia Introduction & Objectives: To identify independent risk factors for developing subsequent bladder cancer after surgical management of upper urinary tract transitional cell carcinoma (UUT-TCC). To define whether the development of bladder cancer has influence on the survival of patients who underwent surgical management of UUT-TCC. Material & Methods: This study included 92 patients treated surgically for UUTTCC. 31 patients with a previous history of bladder cancer, 28 patients with concomitant blader cancer and 3 patients who died in the first 6 months after surgery were excluded. The median follow-up after surgery was 39.5 months (range, 6 to 112 months). To identify the factors associated with the development of subsequent bladder cancer after surgical management of UUT univariate and multivariate analyses using the logistic regression model were performed. The intravesical disease-free rate and survival were calculated by the Kaplan-Meier method, and the log-rank test was used for the statistical differences. Results: Of the 92 patients, 20 (21.7%) patients treated for UUT-TCC developed subsequent bladder tumours, at a mean (range) interval of 16.3 (3-84) months. Out of 20 patients, 17 (85%) developed subsequent bladder tumours less than 2 years after their UUT tumour has been removed. In a multivariate analysis, tumour multifocality was the only independent predictor associated with the development of subsequent bladder cancer (P=0.028) with a risk ratio (RR) of 3.52 (95%CI=1.14210.848). Intravesical recurrence-free survival rates for these 92 patients at 1, 3, 5 and 7 years were 85.8%, 80%, 79.3%, 78.3%, respectively. Patients with tumours extending to multiple sites were significantly more likely to undergo subsequent intravesical recurrence compared with those with tumours located at a single site (P=0.006, Log Rank). Development of bladder cancer has no significant effect on survival of patients who underwent surgical management of UUT-TCC, compared with patients without bladder cancer development (P=0.117). Conclusions: The multiplicity of the tumour of the uper urothelium is independent risk factor for the occurence of urinal bladder cancer. The occurence of the urinal bladder tumour after the surgical extirpation of the primary tumour does not have an impact on the survival of the patients.
S152
Comparison of full-dose intravesical BCG versus half dose BCG and Mitomycin-C in treatment of patients with superficial bladder cancer
Yari H.1, Fallahnezhad M.2, Haji Karim B.3, Tavasoli Shirvan S.2 1 Ayatollah Mosavi Hospital, Zanjan University of Medical Science, Dept. of Urology, Zanjan, Iran, 2Razi Science Researchers Institute, Dept. of Researches, Tehran, Iran, 3Vali-E-Asr Hospital, Zanjan University of Medical Science, Dept. of Infectious Diseases, Zanjan, Iran Introduction & Objectives: Respecting to this fact that recurrence is a wellknown complication of standard treatment of superficial bladder cancers, this study aimed to compare long term results of full dose intravesical BCG versus half dose intravesical BCG combined with Mitomycin-C in patients with superficial bladder cancer who were admitted in Shahid- Modarres hospital-Tehran from March 2005 to March 2008. Material & Methods: This is a clinical trial which conducted on 60 cases of confirmed superficial bladder cancers. Patients randomized into two groups. In group A, patients received intravesical BCG 120 mg/week for 6 weeks and group B patients received 20 mg Mitomycin-C and 60 mg BCG weekly for 6 weeks, intravesically. Treatment results evaluated as recurrence rate in a follow-up period
Eur Urol Suppl 2010;9(6):595
of at least 21 months, and complications including fever, dysuria and frequency and generalized symptoms (e.g. malaise) in short time follow-up period assessed. Results: 8 cases interrupted the trial for different reasons. In group A, fever was occurred in 28.6% of cases, dysuria in 60.7% of cases, frequency in 71.4% and generalized symptoms in 32.1% of cases. In group B patients, these problems observed in 11.1%, 40.7%, 44.4% and 11.1% of cases, respectively. Tumor recurrence rate in group A was 32.1% and it was 11.1% in group B patients (p< 0.07). Conclusions: Intravesical instillation of half-dose BCG combined with half-dose Mitomycin-C seems to be more effective than intravesical administration of fulldose BCG. Further studies in this field are recommended.
S153
Extended pelvic lymphadenectomy at the time of radical cystectomy for muscle-invasive bladder cancer
Smilov N.1, Halachev N.1, Lozev I.2, Lozev P.1 1 Medical Institute Ministery of Interiors, Dept. of Urology, Sofia, Bulgaria, 2Medical Institute Ministery of Interiors, Dept. of Surgery, Sofia, Bulgaria Introduction & Objectives: We assess retrospectively the results of extended pelvic lymphadenectomy in the treatement of muscle-invasive bladder cancer for staging of the disease and the frequency of perioperative complications. Material & Methods: From January 2006 to June 2010, 35 radical cystectomys with extended pelvic lymph node dissections, were completed for muscle–invasive (T3a min) and recidive low-differentiated localized (T2 G3) bladder cancer. The extended pelvic lymphadenectomy included the removal of lymph nodes between the genitofemoral nerve; the external iliac vessels and the obturator fossa (with dissection of the nodes around the obturator nerve and behind the iliac vessels), in medial direction extending to the bladder fascia. The distal border of dissection is the deep iliac circumflex artery with the Cloquet node in the femoral canal ; and includes in the proximal direction the removal of the paraaortal, paracaval and presacral lymph nodes reaching the level of inferior mesenteric artery. We analyse the number of the positive nodes in the different groups; the operative time lengthening related with the dissections, the type and the frequency of the dissection-related complications. Results: There is a total number of 612 lymph nodes removed (an average 19 per patient (ranging from 11 to 34); positive for methastatic invasion are 61 (9.7%) lymph nodes. Positive to nodal methastic involvement are 12 patients, as follows in each stage- T2 – 1 patient; in T3 – 8 patients; in T4 – 3 patients. The specific lymph node groups involvement is : the obturator group – 24.5%; external iliac-19.7%; internal iliac – 13.1%; common iliac -11.5%; paravesical 9.8%; paracaval 8.2%; paraaortal 8.2%; presacral 4.9% The operative time for the lymphadenectomy is approximately 90 min., with complementary extension reaching 60 min, in case of preceding radiation therapy, extraordinarily obese patient or other anatomic peculiaritys. There are no intraoperative complications (like injuries of major blood vessels, nerves or viscera) There is no case of intraoperative mortality.We have accepted as dissection-related complications: lymphorrhea lastng over 2 weeks in 6 patients; temporary lymphoedema in lower limbs – in 2 patients; lymphocele -1 patient; pulmonary embolism – in 1 patient. Conclusions: At present, there is no standard concent for the limits of the lymphadenectomy at the time of surgery for muscle–invasive bladder cancer. The retrospective analysis of our data helps us to claim that the extended lymph node dissection with proximal border the inferior mesenteric artery take the chance for better staging and potential improvement in survival of the patients, at the cost of acceptable length of the surgical time, and type and frequency of complications comparable with the conventional lymphadenectomy.
S154
Superficial bladder cancer and overexpression of p53
Lepara Z.1, Junuzović D.1, Bajramović S.1, Lepara O.2 1 Clinical Centre University of Sarajevo, Dept. of Urology, Sarajevo, Bosnia and Herzegovina, 2Medical Faculty, Institute of Physiology, Sarajevo, Bosnia and Herzegovina Introduction & Objectives: Superficial bladder cancer usually presents challenge and treatment dilemma for the urologist. Evaluation of p53 overexpression can helps us to determine early progression and recidivism of these tumors. Material & Methods: We have done open prospective study of 243 patients both male and female age ranged from 49-78 years with diagnosed transitional cell carcinoma (TCC) of bladder after initial TURBT. Additionally p53 overexpression was assessed by immunohistochemistry (IHC). The pathological stage and IHC score were assigned by one pathologist. We have focused our study to pT1 grade 2 TCC of bladder and correlation to p53 overexpression. Patients were divided into two groups with positive p53. Group (A)-less than 20% of tumor’s cells positive to p53 and group (B)-more than 20% tumor’s cells positive to p53. Patients with multilocular tumor and tumor greater than 3 cm were excluded. Follow up was regularly done by urine cytology and cystoscopy after 3 months regularly for the first year. For comparisons and correlation of the parameters we used chi-square test, Pearson’s index, Fischer’s and Wilcoxon test and multivariate analysis (p<0,05).
Eur Urol Suppl 2010;9(6):596
Results: Thirty six patients were diagnosed with pT1 grade 2, all less than 3 cm and unilocular tumor and positive p53. In group A we had 20 patients who had recidivism of the disease after 9 months into the same grade. In group B we had 16 patients who had recidivism after first 3 months follow up and eight of them had progression into pT2 TCC of bladder (p<0,05). Conclusions: Immunohistochemistry approved presence of p53 of tumor’s cell of TCC of bladder is in corellation with early and rapid recidivism and progression of disease.
S155
The coping and help seeking behaviours for management of urinary incontinence problem
Bilgic D.1, Kızılkaya Beji N.1, Ozbas A.2, Cavdar I.2, Aslan E.1, Yalcın O.1 1 Istanbul University Florence Nightingale College of Nursing, Dept. of Obstetric and Gynecologic Nursing, Istanbul, Turkey, 2Istanbul University Florence Nightingale College of Nursing, Dept. of Surgical Nursing, Istanbul, Turkey Introduction & Objectives: This study was designed to determine the coping styles of individuals with urinary incontinence problem and their help seeking behaviours. Material & Methods: The study was conducted at Istanbul Medical Faculty Urogynecology and Urology Outpatient Clinic between January and June 2010. The study sample consisted of 130 women and 50 men who were diagnosed with urinary incontinence; and who were willing to participate in this study. The data were collected in an interview using a questionnaire covering 29 questions. Data analysis was performed using SPSS software. Results: The women’s mean age was 48±10, the men’s mean age was 67.5±9.7. More than half of the women (55.4%) had continuous urinary incontinence and 57.7% of them were too much bothered with this problem. The duration of urinary incontinence in women was 8±7 years, in men was 2.3±2 years. One third of men (31.4%) had continuous urinary incontinence and 41.2% of men were too much bothered with this problem. More than half of women (55.8%) reported that the first time they experienced urinary incontinence, they ignored it, hid it and preferred not to mention about it to anybody. It was determined that 50.4% of women did not seek help for urinary incontinence. Most women (60%) sought medical advice 1-5 years later following occurrence of initial urinary incontinence, 14.6% of them went to a physician in following 6-10 years. Nearly one third of the men (29.4%) expressed that for first when they experienced the urinary incontinence problem, they kept this problem secret and did not share it with anybody. More than half of men (52.9%) sought medical advice for the management of urinary incontinence problem. Forty eight percent of men consulted a physician 1-3 months after the urinary incontinence occurred. Coping behaviours of both groups for management of the urinary incontinence symptoms were: keeping feet warm, performing hot application to perineum, going frequently to toilet despite the lack of sense of urgency to urinate, having a bath more often than usually, reducing the amount of daily drinking water, using pad, cloth pads etc., changing underwear/carrying spare clothes, cleansing using hot water, looking for foreground toilet in unknown places, preferring to go to the places especially with toilet, and preferring clothes which are taken off easily, wearing long pants/tights etc., restricting the physical activity, restraining from the social life, and praying etc. Conclusions: While women mostly do not prefer to seek medical advice for urinary incontinence problem, men tend to go to the doctors more often than women. Except for treatment seeking behaviours, both men and women are practicing coping methods for the management of urinary incontinence such as going frequently to toilet, keeping feet warm, hot application to perineum etc.
S156
Comparison of cystoscopy with diffusionweighted magnetic resonance images used in the diagnosis and follow-up of patients with bladder tumor
Ceylan K.1, Taken K.1, Geçit I.1, Pirinççi N.1, Güneş M.2, Karaman M.1 1 YYU Faculty of Medicine, Dept. of Urology, Van, Turkey, 2Van Dİvan Hayat Hospital, Dept. of Urology, Van, Turkey Introduction & Objectives: To compare diffusion-weighted magnetic resonance imaging (DW-MRI) with cystoscopy in the diagnosis and follow-up of patients with bladder tumor and to investigate histopathological correlation. Material & Methods: A total number of 59 patients, between 31-85 years (mean age 60 ± 13.03) who referred to our clinic due to a hematuria complaint were enrolled into the study. Patients were evaluated by USG for an upper urinary system pathology and then DW-MRI (average 7 days) and cystoscopy were conducted. Apparent diffusion coefficient (ADC) of images was calculated from the tissues and bladder masses that belong to a normal bladder mucosa. Results: A mass was determined in 43 patients out of 59 (n= 34 malign, n=9 benign) patients with DW-MRI by the means of cystoscopy while no any masses were determined in 16 of the patients. Regarding ADC values, mean ADC values of 34 patients who were diagnosed with a bladder tumor (1,05 ± 0.22 x 10־³mm²/s), was significantly lower than the mean ADC values obtained from the normal bladder wall (1,830 ± 0.18 x 10־³mm²/s) whereas a statistically significant difference was found (p<0.001). ADC values in 9 patients with a benign lesion