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S154 SUPERFICIAL BLADDER CANCER AND OVEREXPRESSION OF P53
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
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