THE ROLE OF URETHRAL FROZEN SECTION AT CYSTECTOMY IN THE MANAGEMENT OF BLADDER CANCER

Vol. 179, No. 4, Supplement, Tuesday, May 20, 2008

5 DQGGLVWDQWPHWDVWDVHV0YV0 UHYHDOHGVLJQL¿FDQWVXUYLYDO GLIIHUHQFHV ,Q PXOWLYDULDWH DQDO\VLV RQO\ 7 VWDJH KD]DUG UDWLR >+5@ 1.40, 95%CI, 1,04 to 1,87, p=0,024), N stage (HR 1,71, 95%CI, 1,12 to 2,61, p=0,013) and the surgical margins (HR 3,00, 95%CI, 1,74 to 5,15, S ZHUHSURJQRVWLFIDFWRUVWKDWDIIHFWHGFDQFHUVSHFL¿FVXUYLYDO In combination with all investigated factors the parameters gender, body PDVVLQGH[DQGK\GURQHSKURVLVGLGQRWDIIHFWFDQFHUVSHFL¿FVXUYLYDO CONCLUSIONS: The factors gender, body mass index and K\GURQHSKURVLV GLG QRW GHPRQVWUDWH D VLJQL¿FDQW LPSDFW RQ EODGGHU FDQFHUVSHFL¿FVXUYLYDODGMXVWHGIRUDOORWKHULQYHVWLJDWHGSDUDPHWHUV By contrast, the long-established parameters such as T stage, N stage and surgical margins prove as independent prognostic factors of patients undergoing radical cystectomy for bladder cancer. Source of Funding: None

1613 THE ROLE OF URETHRAL FROZEN SECTION AT CYSTECTOMY IN THE MANAGEMENT OF BLADDER CANCER Ardalan E Ahmad*, Anobel Y Odisho, Kirsten L Greene, Maxwell V Meng, Peter R Carroll, Badrinath R Konety. San Francisco, CA. ,1752'8&7,21$1' 2%-(&7,9( :KLOH XUHWKUDO IUR]HQ section (FS) is routinely performed in patients with bladder cancer undergoing radical cystectomy, the utility of such FS examination is unclear. We sought to examine the prevalence of distal urethral FS examination at cystectomy, its correlation with ureteric FS, and its impact on intra-operative decision making. 0(7+2'6 :H LGHQWL¿HG  FRQVHFXWLYH PDOH SDWLHQWV diagnosed with bladder cancer who underwent radical cystectomy with either neobladder (n=121) or ileal conduit formation (n=79) from our institutional database. Of these, 43 patients did not have a FS of the urethral margins and were excluded. Demographic, clinical and pathological variables of the remaining 157 patients were examined retrospectively. RESULTS: 35/157 (22%) of patients had pre-operative prostatic urethral biopsy of whom 14 (40%) were positive. Of these 14 patients, 6 (43%) also had a positive distal urethral FS at cystectomy. 2/21 (10%) of patients with negative pre-cystectomy prostatic urethral biopsies had positive urethral FS at cystectomy. Overall, 17/157 (11%) of urethral FS were positive and 140 had ureteric FS, of which 16% were SRVLWLYH$Q DGGLWLRQDO  SDWLHQWV ZLWK QHJDWLYH )6 KDG ¿QDO XUHWKUDO margins that were positive. This yielded a sensitivity for urethral FS of 74% and NPV of 96%. Among 17 patients with positive urethral FS, 6 (35%) had neobladder and 11(65%) had ileal conduit urinary diversion. 7KHXUHWKUDO)6¿QGLQJVGLGQRWDOWHUWKHSUHRSHUDWLYHO\SODQQHGXULQDU\ diversion in any of the 14 patients for whom such data was available. Results of ureteric FS were not correlated with results of urethral FS (Fishers exact p=0.23, Table). CONCLUSIONS: The prevalence of a positive margin at the urethra on FS at cystectomy is low and similar to that of positive ureteric FS. Urethral FS results rarely altered pre-operatively planned diversion or extent of surgery. There is no correlation between the urethral FS result DQGWKHXUHWHULF)6UHVXOW%DVHGRQWKHVH¿QGLQJVDQGWKHIDFWWKDW many advocate eliminating ureteric FS examination, one could consider eliminating urethral FS examination as well particularly in those patients with no cystoscopic evidence of prostatic urethral involvement. Ureteric and Urethral FS Results (+) FS Ureter (+) FS Urethra 4 (-) FS Urethra 18

(-) FS Ureter 11 107

Source of Funding: None

1614 THE USEFULNESS OF MEASURING THE INTRA-ABDOMINAL VISCERAL FAT AREA TO PREDICT THE POSTOPERATIVE ILEUS AFTER RADICAL CYSTECTOMY Sung Han Kim*, In Gab Jeong, Jeong Woo Lee, Jin Mo Um, Sang Eun Lee, Eunsik Lee. Seoul, Republic of Korea. INTRODUCTION AND OBJECTIVE: This study is objected to assess the usefulness of measuring the visceral fat area (VFA) for

THE JOURNAL OF UROLOGY®

551

predicting the postoperative ileus among the patients with bladder cancer, who had received radical cystectomy. METHODS: A retrospective study was performed with 223 consecutive patients with bladder cancer who had received radical cystectomy between January 2001 and May 2007. The abdominal circumference (AC), the abdominal anterior-posterior and transverse diameters (APD and TD), and intra-abdominal VFA were determined at the umbilical level by the previously reported CT scanning technique. 9)$ZDVGH¿QHGDVDQ\DUHDZLWK+RXVH¿HOGLQWHQVLW\RIEHWZHHQ DQG+8DQGPHDVXUHGXVLQJ5DSLGLDSURJUDP,Q¿QLWW6HRXO 7KH comparisons of the differences of clinico-pathological factors and the anthropometric parameters were performed between those patients with postoperative ileus and the others with non-postoperative ileus. Logistic regression analysis was used to assess the possibility of the above factors for the prediction of postoperative ileus. RESULTS: Mean age of study subject was 63.6 years and there were 194 (87%) male patients. 93 (42%) patients received orthotopic bladder substitution. The postoperative ileus occurred in 51 (23%) patients and 19 (8.5%) patients had major complications. There were no differences in sex, age, type of operations, operative time, and blood loss between those with ileus group and the others with non-ileus group. There was also no difference in pathological stage, whereas the major complications occurred higher in postoperative ileus group. When compared anthropometric parameters, there were no differences in BMI (23.3kg/m2 vs. 23.1kg/m2, p=0.709), AC (85.9cm vs. 84.2cm, p=0.199), APD (21.8cm vs. 20.9cm, p=0.100), TD (30.4cm vs. 30.1cm, p=0.560), and in VFA (115cm2 vs. 100cm2, p=0.093). Whereas the ratio of VFA DPRQJWKHDEGRPLQDOFURVVVHFWLRQVZDVVLJQL¿FDQWO\GLIIHUHQWEHWZHHQ two groups (22.0% vs. 19.2%, p=0.027). Although BMI, AC, APD, TD, and as well as clinico-pathological factors were not a predictor for postoperative ileus in multivariate analysis, the presence of associated major complications and the ratio of VFA among the abdominal cross VHFWLRQVZHUHVWDWLVWLFDOO\VLJQL¿FDQWSS   CONCLUSIONS: The ratio of the VFA among the intraabdominal cross sections was a useful predicting factor for the postoperative ileus after radical cystectomy. Source of Funding: None

1615 PROGNOSIS OF PATHOLOGICAL T3a AND b BLADDER CANCER: NO DIFFERENCE BETWEEN PRIMARILY INVASIVE AND INITIALLY SUPERFICIAL BUT SUBSEQUENT PROGRESSIVE INVASIVE DISEASE Nivedita Dhar*, George N Thalmann, Pascal Zehnder, Karsten Reinhardt, Urs E Studer. Bern, Switzerland. INTRODUCTION AND OBJECTIVE: To determine if a SURJQRVWLFGLIIHUHQFHH[LVWVEHWZHHQSULPDU\DQGLQLWLDOO\VXSHU¿FLDOEXW subsequently progressive invasive pathological pT3a and b transitional cell carcinoma (TCC) of the bladder. METHODS: From 1987 to 2005, a consecutive series of 900 patients underwent radical cystectomy (RC) and extended bilateral pelvic lymphadenectomy at our institution for TCC of the bladder. Of these, 900 patients, 109 (20 women, 89 men) were found to have pathological pT3a and b after undergoing surgery either for primary invasive disease (n=  RULQLWLDOO\VXSHU¿FLDOEXWVXEVHTXHQWO\SURJUHVVLYHLQYDVLYHGLVHDVH Q  3ULRUWRF\VWHFWRP\PDQDJHPHQWRIWKHLQLWLDOO\VXSHU¿FLDOEXW subsequently progressive disease patients was conducted at outside institutions. Baseline data including patient and tumor characteristics were collected at the time of the invasive tumors diagnosis. The duration RIVXUYLYDOZDVGH¿QHGDVWLPHIURP5&WRGLVHDVHVSHFL¿FGHDWK7KH 2-sample tests were used to compare the cumulative incidence of death due to TCC between primary and progressive patients. RESULTS: Median age at time of RC was 66 years (range:    2I WKH  SDWLHQWV ZLWK LQLWLDOO\ VXSHU¿FLDO EXW VXEVHTXHQW progressive invasive disease, 2 TURBTs were performed on 15 patients, 3 on 23 patients, 4 on 9 patients, 5 on 3 patients, 6 on 2 patients, 7 on 2 patients and 9 on 1 patient. Of these 55 patients, 14 received intravesical BCG, 5 for carcinoma in situ and 9 for T1G3 disease. One patient had half a course of BCG, 10 patients 1 course, 1 patient 2 courses, and 2 patients had 3 courses. Of the 109 patients, 38 were found to have positive nodes on histologic examination. There was no evidence of a