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TRANSURETHRAL LAYER SECTION OF MUSCLE INVASIVE BLADDER CANCER: ACCURATE T-STAGING AND BLADDER PRESERVATION IN A SELECTED T2 BLADDER CANCER
593 EFFECTS OF TISSUE CULTURED MOUNTAIN GINSENG (PANAX GINSENG C.A. MEYER) EXTRACT IN MALE PATIENT WITH ERECTILE DYSFUNCTION
594 CAN INTRACAVERNOSAL INJECTION THERAPY SALVAGE PDE5 INHIBITOR (PDE5I) FAILURES? Muller A., Mulhall J.P.
Kim T.H.1, Jeon S.H.1, Chang S.G.1, Kim J.I.1, Lee C.H.1, Lee H.L.1, Huh J.S.2 School of Medicine, Kyung Hee University, Dept. of Urology, Seoul, South Korea, 2Cheju University College of Medicine, Dept. of Urology, Jeju, South Korea
1
Introduction & Objectives: Korean ginseng and Korean red ginseng were widely known traditional herbal plant for improvement of sexual function. Mountain ginseng (Panax ginseng C.A. Meyer) has more kinds of saponins DQGKLJKFRQFHQWUDWLRQRIWRWDOVDSRQLQWKDQJLQVHQJDQGUHGJLQVHQJ,QWKLVVWXG\ZHLQYHVWLJDWHGWKHHᚎHFWV of tissue cultured mountain ginseng extract (TMGE) in the male patients with erectile dysfunction. Material & Methods: $ WRWDO RI SDWLHQWV ZLWK HUHFWLOH G\VIXQFWLRQ HQUROOHG LQ D GRXEOH EOLQG SODFHER controlled study. In 8 weeks, one group took TMGE 1000mg, the other took placebo 1000mg twice a day. The HᚎHFWVRI70*(DQGSODFHERZHUHFRPSDUHGXVLQJWKH.RUHDQYHUVLRQRI,QWHUQDWLRQDO,QGH[RI(UHFWLOH)XQFWLRQ (IIEF) questionnaire. Results: ,QWKLVVWXG\SDWLHQWVFRPSOHWHGWKHZHHNVPHGLFDWLRQ7KHVFRUHVRIᚏYHGRPDLQVRI,,()DIWHUWKH PHGLFDWLRQZHUHVLJQLᚏFDQWO\KLJKHUFRPSDUHGZLWKWKDWWKHEDVHOLQHLQWKH70*(JURXS UHVSHFWLYHO\S 7DEOH %XWDVLJQLᚏFDQWLPSURYHPHQWZDVQRWREVHUYHGLQWKHSODFHERJURXS S! $IWHUWKHPHGLFDWLRQ the TMGE treated group was compared to the placebo group, erectile function and overall satisfaction domain VFRUHV DPRQJ WKH ,,() ᚏYH GRPDLQV ZHUH VLJQLᚏFDQWO\ KLJKHU LQ WKH 70*( JURXS WKDQ LQ WKH SODFHER JURXS (respectively, p<0.05). Table 1. The change of International Index of Erectile Dysfunction (IIEF) scores in tissue cultured mountain gingseng extract (TMGE) treated group and placebo treated group. EF : erectile function, OF RUJDVPLFIXQFWLRQ6' VH[XDOGHVLUH,6 LQWHUFRXUVHVDWLVIDFWLRQ26 RYHUDOOVDWLVIDFWLRQ,,() ᚏYHLWHP version of international index of erectile function Group(n) Total IIEF EF domain OF domain SD domain IS domain OS domain IIEF-5
Pre-medication 0HDQs6' TMGE(65) Placebo(21) TMGE(65) Placebo(21) TMGE(65) Placebo(21) TMGE(65) Placebo(21) TMGE(65) Placebo TMGE(65) Placebo(21) TMGE(65) Placebo(21)
Post-medication
p-value
s s s s s s s s s s s s s s
s s s s s s s s s s s s s s
Introduction & Objectives: 3'(LDUHDQH[FHOOHQWᚏUVWOLQHWUHDWPHQWRIHUHFWLOHG\VIXQFWLRQ (' KRZHYHU D VLJQLᚏFDQW QXPEHU RI SDWLHQWV ZLOO IDLO WR UHVSRQG 'DWD VXSSRUWV WKH FRQFHSWWKDWWKDWRIಫIDLOXUHVಬZLOOUHVSRQGRQUHFKDOOHQJHRQFHGRVHWLWUDWHGDQG educated regarding correct use of the medication. Despite these manoeuvres, some mne will not respond to oral therapy. Anecdotal experience has suggested that some failures can be salvaged by exposure to short-term intracavernosal injection (ICI) therapy. This study ZDVXQGHUWDNHQSURVSHFWLYHO\WRGHᚏQHZKHWKHU3'(LIDLOXUHVFRXOGEHVDOYDJHGWKURXJK the use of ICI. Material & Methods: 3DWLHQWV ZLWK (' ZKR KDG IDLOHG VLOGHQDᚏO QR DELOLW\ WR DFKLHYH penetration with 100mg, on at least 4 occasions, taken prepandially) who pursued intracavernosal injection (ICI) therapy constituted the study population. All patients completed ,,()TXHVWLRQQDLUHVDQGDJOREDOHᚑFDF\TXHVWLRQ *(4 SULRUWRWU\LQJVLOGHQDᚏORQVLOGHQDᚏO DQGRQ,&,7KHSDWLHQWVZHUHHQFRXUDJHGWRUHFKDOOHQJHWKHPVHOYHVZLWKVLOGHQDᚏODWOHDVW PRQWKVDIWHUFRPPHQFLQJLFL7KH*(4DVNHGಯKDVWKHPHGLFDWLRQ VLOGHQDᚏORULQMHFWLRQ JLYHQ\RXWKHDELOLW\WRDFKLHYHYDJLQDOSHQHWUDWLRQರ/RJLVWLFUHJUHVVLRQZDVXVHGWRGHᚏQH SUHGLFWRUVRIVLOGHQDᚏOUHVSRQVHRQUHFKDOOHQJH Results: 76 patients were included in this analysis. The mean age and ED duration ZHUH s \HDUV DQG s \HDUV &RPRUELGLW\ SURᚏOH LQFOXGHG K\SHUWHQVLRQ hyperlipidemia 18%, diabetes 14%, coronary artery disease 12%, radical prostatectomy %0,!FLJDUHWWHVPRNLQJKLVWRU\ FXUUHQWRUSDVW ZLWKDPHDQSDFN\HDU H[SRVXUHLQWKLVJURXSRIs$OOSDWLHQWVZHUHGHHPHGWRKDYHKDGDVXERSWLPDOUHVSRQVH WR VLOGHQDᚏO E\ VHOIUHSRUW ZLWK PHDQ SUH DQG SRVWVLOGHQDᚏO () GRPDLQ VFRUHV RI s DQGs,&,GXUDWLRQDWWLPHRIVLOGHQDᚏOUHFKDOOHQJHZDVsPRQWKV0HDQ()GRPDLQ VFRUHRQ,&,ZDVs VLOGHQDᚏOIDLOXUHVUHVSRQGHGWR,&,ZLWKSHQHWUDWLRQ KDUGQHVV 6LOGHQDᚏO UHFKDOOHQJH XVHG PJV RQ RFFDVLRQV ZHUH QRZ FDSDEOHRIVH[XDOLQWHUFRXUVHZLWKDUHFKDOOHQJH()GRPDLQVFRUHRIs,QWKHPHQZKR ZHUHVDOYDJHGWKH()'URVHIURPsWRs3UHGLFWRUVRIIDLOXUHWRUHVSRQGWRVLOGHQDᚏO RQUHFKDOOHQJHZHUHGLDEHWHV 25 S FLJDUHWWHVPRNLQJH[SRVXUH!SDFN\HDUV 25 S %0,! 25 DQG53 25 S
<0.00 0.242 <0.00 0.008 0.199 <0.00 0.411 0.001 0.859 <0.00 0.106 <0.00 0.471
Conclusions: 7KH HUHFWLOH IXQFWLRQ RI SDWLHQWV LQ 70*( JURXS ZDV VLJQLᚏFDQWO\ LPSURYHG 7LVVXH FXOWXUHG mountain ginseng extract might be useful as alternative agent for improving erectile function in male patients with erectile dysfunction
O9
Memorial Sloan-Kettering Cancer Centre and Weill Medical College of Cornell University, New York, United States of America
Conclusions: We have demonstrated that approximately one quarter of men who fail PDE5i can be salvaged by the use of intracavernosal injection, especially if they are not diabetic, obese, a cigarette smoker or have not had RP.
TREATMENT OF ADVANCED STAGE BLADDER AND UPPER URINARY TRACT CANCER
Thursday, 27 March, 15.45-17.15, Gold Hall
595
596
ARE COMORBIDITIES INDEXES ADEQUATE AND RELIABLE IN DETAILING MEDICAL SEVERITY IN PATIENTS UNDERGOING RADICAL CYSTECTOMY. A 10-YEAR TIME FRAME EXPERIENCE
TRANSURETHRAL LAYER SECTION OF MUSCLE INVASIVE BLADDER CANCER: ACCURATE T-STAGING AND BLADDER PRESERVATION IN A SELECTED T2 BLADDER CANCER
Salonia A.S., Maccagnano M.C., Gallina G.A., Colombo C.R., Da Pozzo D.L., Zanni Z.G., Rocchini R.L., Tutolo T.M., Camerota C.T., Rigatti R.P., Montorsi M.F.
Lee J.S.1, Choi Y.D.2, Cho K.S.2, Ham W.S.2, Cho N.H., Kim W.T.2 1
8QLYHUVLW\9LWD6DOXWH6DQ5DᚎDHOH'HSWRI8URORJ\0LODQ,WDO\ Introduction & Objectives: To assess whether widely used comorbidity indexes indices can be adequate and reliable in detailing medical severity in urologic patients undergoing radical cystectomy (RC) performed for muscle-invasive bladder cancer (MIBC) over 10 years at the same academic institution. Material & Methods: We reviewed all clinical records of n=51 and n=70 consecutive patients who underwent RC for MIBC in either 1996 (group 1) or 2006 (group 2), respectively. For study SXUSRVHV WKH WZR JURXSV ZHUH FRPSDUHG IRU SDWLHQWVಬ SUHRSHUDWLYH FKDUDFWHULVWLFV >LH DJH medical history, Body Mass Index (BMI), Charlson Comorbidity index (CCI), European System for Cardiac Operative Risk Evaluation (EuroSCORE), American Society of Anesthesiologists $6$ SK\VLFDO VWDWXV@ DQG SRVWRSHUDWLYH RXWFRPH GDWD >LH QXPEHU RI SHULVXUJHU\ PHGLFDO and surgery-requiring complications, number of transfusions until the hospital discharge]. The VWDWLVWLFDOVLJQLᚏFDQFHRIGLᚎHUHQFHVLQPHDQVDQGSURSRUWLRQVZHUHWHVWHGZLWKWZRWDLOHGWWHVW DQGWKHFKLVTXDUH ˴2) tests, respectively. Results: *URXSVZHUHFRPSDUDEOHLQWHUPVRIPHDQs6'DJH LHJURXSYVJURXS s YVs \U3 %0, s YVsNJP23 &KDUOVRQ,QGH[ s YV s 3 (XUR6&25( s YV s 3 DQG $6$ SK\VLFDO VWDWXV s YVs3 $JUHDWHUSURSRUWLRQRIJURXSSDWLHQWVVXᚎHUHGIURPK\SHUWHQVLRQ YV ˴2 3 DQGFKURQLFDWULDOᚏEULOODWLRQ YV ˴2 3 DV compared with group 1 patients. Likewise, a higher proportion of group 2 patients did use either ZDUIDULQRUDQWLDJJUHJDQWWKHUDS\ YV ˴2=4.5, P=0.02). Types of urinary diversion VLJQLᚏFDQWO\FKDQJHGRYHUWKHGHFDGH QDPHO\XUHWHURVLJPRLGRVWRP\LQ YV LOHDO FRQGXLWDFFRUGLQJWR%ULFNHULQYV XUHWHURFXWDQHRVWRP\LQYV DQG RUWKRWRSLF QHREODGGHU LQ YV 3 3URSRUWLRQV RI SHUL DQG SRVWRSHUDWLYH FRPSOLFDWLRQV UHTXLULQJ VXUJLFDO UHGR JURXS YV JURXS YV ˴2 3 DQGRISDWLHQWVZKRSRVWRSHUDWLYHO\GLHG YV ˴2 3 ZHUHVLPLODUEHWZHHQ JURXSV,QFRQWUDVWJURXSSDWLHQWVKDGDVLJQLᚏFDQWO\JUHDWHUUDWHRIFRPSOLFDWLRQVZKLFKQRW UHTXLUHGVXUJHU\ LHGHHSYHQRXVWKURPERVLVGHQRYRDWULDOᚏEULOODWLRQHLWKHUDQWLELRWLFWKHUDS\ SHUVLVWLQJ KLJK WHPSHUDWXUH RU VHSVLV GLᚑFXOWWREHFRQWUROOHG K\SHUWHQVLRQ HWF YV ˴2 3 6LPLODUO\SRVWRSHUDWLYHKRVSLWDOVWD\ZDVVLJQLᚏFDQWO\ORQJHUIRUJURXS SDWLHQWV s YVs G3 Conclusions: Although patients medical conditions at baseline were similar in the two groups we observed a 10-yr time frame increase in terms of clinical severity of MIBC patients undergoing RC thus requiring a greater postoperative medical care and a longer hospital stay.
Kwandong University College of Medicine, Dept. of Urology, Goyang, South Korea, Yonsei University College of Medicine, Dept. of Urology and Urological Science Institute, Seoul, South Korea, Yonsei University College of Medicine, Dept. of Pathology, Seoul, South Korea
2
Introduction & Objectives: We evaluated the feasibility of transurethral layer section of muscle bladder tumour (TULSB) for T staging and the outcomes of bladder preservation by TULSB in T2 muscle-invasive bladder cancer without chemotherapy or radiotherapy. Material & Methods: From 1997, 497 patients in whom an invasive is suspected were treated by TULSB. For TULSB, main tumour was completely removed with TURB (transurethral resection of bladder tumour) and then additional successive resection RI PRUH WKDQ PXVFOH OD\HUV ZDV VHULDOO\ SHUIRUPHG XQWLO SHULYHVLFDO DGLSRVH WLVVXH ZDV VDPSOHG %ODGGHU SUHVHUYDWLRQ ZDV OLPLWHG WR SDWLHQWV ZLWK VHULDO FRQᚏUPDWLRQ RI tumour negativity on additional resection layers below tumour base. Among the patients, SDWLHQWVZLWK7PXVFOHLQYDVLYHEODGGHUFDQFHUFRQᚏUPHGE\78/6%ZHUHHQUROOHGIRU bladder preservation protocol without chemotherapy or radiation therapy. Median followXSGXUDWLRQZDV PRQWKV Results: Among the patients in whom an invasive is suspected were treated by TULSB, T stage were consisted of 260 patients in T1, 118 patients in T2, and 119 patients in PRUHWKDQ7,Q SDWLHQWVUDGLFDOF\VWHFWRP\ZDVGRQHDIWHU78/6%GXHWRSDWLHQWಬV no consent. In cystectomy specimens, all had no residual muscle invasive tumour in EODGGHU%XW SDWLHQWVVKRZHGWKHUHVLGXDOVXSHUᚏFLDOFDQFHUDQGSDWLHQWVVKRZHG the carcinoma in situ. Of 99 patients with T2 muscle invasive bladder cancer treated with only TULSB were enrolled for bladder preservation, 57 patients (57.6%) showed no UHFXUUHQFHEXWSDWLHQWV H[SHULHQFHGEODGGHUUHFXUUHQFHSDWLHQWVVKRZHG WKH VXSHUᚏFLDO UHFXUUHQFH WKDW ZDV WUHDWHG ZLWK 78/6% SDWLHQWV VKRZHG progression and were treated with cystectomy and chemotherapy. 5 patients died of GLVHDVH\HDUGLVHDVHVSHFLᚏFVXUYLYDOUDWHZDV Conclusions: TULSB can select the T2 muscle-invasive bladder cancer among the patients in whom an invasive is suspected. In selective T2 muscle invasive bladder FDQFHU EODGGHU FDQ EH SUHVHUYHG E\ WUDQVXUHWKUDO OD\VHFWLRQ FRQᚏUPDWLRQ RI WXPRXU negativity without chemotherapy or radiation therapy.
Eur Urol Suppl 2008;7(3):219
594 CAN INTRACAVERNOSAL INJECTION THERAPY SALVAGE PDE5 INHIBITOR (PDE5I) FAILURES? Muller A., Mulhall J.P.
Kim T.H.1, Jeon S.H.1, Chang S.G.1, Kim J.I.1, Lee C.H.1, Lee H.L.1, Huh J.S.2 School of Medicine, Kyung Hee University, Dept. of Urology, Seoul, South Korea, 2Cheju University College of Medicine, Dept. of Urology, Jeju, South Korea
1
Introduction & Objectives: Korean ginseng and Korean red ginseng were widely known traditional herbal plant for improvement of sexual function. Mountain ginseng (Panax ginseng C.A. Meyer) has more kinds of saponins DQGKLJKFRQFHQWUDWLRQRIWRWDOVDSRQLQWKDQJLQVHQJDQGUHGJLQVHQJ,QWKLVVWXG\ZHLQYHVWLJDWHGWKHHᚎHFWV of tissue cultured mountain ginseng extract (TMGE) in the male patients with erectile dysfunction. Material & Methods: $ WRWDO RI SDWLHQWV ZLWK HUHFWLOH G\VIXQFWLRQ HQUROOHG LQ D GRXEOH EOLQG SODFHER controlled study. In 8 weeks, one group took TMGE 1000mg, the other took placebo 1000mg twice a day. The HᚎHFWVRI70*(DQGSODFHERZHUHFRPSDUHGXVLQJWKH.RUHDQYHUVLRQRI,QWHUQDWLRQDO,QGH[RI(UHFWLOH)XQFWLRQ (IIEF) questionnaire. Results: ,QWKLVVWXG\SDWLHQWVFRPSOHWHGWKHZHHNVPHGLFDWLRQ7KHVFRUHVRIᚏYHGRPDLQVRI,,()DIWHUWKH PHGLFDWLRQZHUHVLJQLᚏFDQWO\KLJKHUFRPSDUHGZLWKWKDWWKHEDVHOLQHLQWKH70*(JURXS UHVSHFWLYHO\S 7DEOH %XWDVLJQLᚏFDQWLPSURYHPHQWZDVQRWREVHUYHGLQWKHSODFHERJURXS S! $IWHUWKHPHGLFDWLRQ the TMGE treated group was compared to the placebo group, erectile function and overall satisfaction domain VFRUHV DPRQJ WKH ,,() ᚏYH GRPDLQV ZHUH VLJQLᚏFDQWO\ KLJKHU LQ WKH 70*( JURXS WKDQ LQ WKH SODFHER JURXS (respectively, p<0.05). Table 1. The change of International Index of Erectile Dysfunction (IIEF) scores in tissue cultured mountain gingseng extract (TMGE) treated group and placebo treated group. EF : erectile function, OF RUJDVPLFIXQFWLRQ6' VH[XDOGHVLUH,6 LQWHUFRXUVHVDWLVIDFWLRQ26 RYHUDOOVDWLVIDFWLRQ,,() ᚏYHLWHP version of international index of erectile function Group(n) Total IIEF EF domain OF domain SD domain IS domain OS domain IIEF-5
Pre-medication 0HDQs6' TMGE(65) Placebo(21) TMGE(65) Placebo(21) TMGE(65) Placebo(21) TMGE(65) Placebo(21) TMGE(65) Placebo TMGE(65) Placebo(21) TMGE(65) Placebo(21)
Post-medication
p-value
s s s s s s s s s s s s s s
s s s s s s s s s s s s s s
Introduction & Objectives: 3'(LDUHDQH[FHOOHQWᚏUVWOLQHWUHDWPHQWRIHUHFWLOHG\VIXQFWLRQ (' KRZHYHU D VLJQLᚏFDQW QXPEHU RI SDWLHQWV ZLOO IDLO WR UHVSRQG 'DWD VXSSRUWV WKH FRQFHSWWKDWWKDWRIಫIDLOXUHVಬZLOOUHVSRQGRQUHFKDOOHQJHRQFHGRVHWLWUDWHGDQG educated regarding correct use of the medication. Despite these manoeuvres, some mne will not respond to oral therapy. Anecdotal experience has suggested that some failures can be salvaged by exposure to short-term intracavernosal injection (ICI) therapy. This study ZDVXQGHUWDNHQSURVSHFWLYHO\WRGHᚏQHZKHWKHU3'(LIDLOXUHVFRXOGEHVDOYDJHGWKURXJK the use of ICI. Material & Methods: 3DWLHQWV ZLWK (' ZKR KDG IDLOHG VLOGHQDᚏO QR DELOLW\ WR DFKLHYH penetration with 100mg, on at least 4 occasions, taken prepandially) who pursued intracavernosal injection (ICI) therapy constituted the study population. All patients completed ,,()TXHVWLRQQDLUHVDQGDJOREDOHᚑFDF\TXHVWLRQ *(4 SULRUWRWU\LQJVLOGHQDᚏORQVLOGHQDᚏO DQGRQ,&,7KHSDWLHQWVZHUHHQFRXUDJHGWRUHFKDOOHQJHWKHPVHOYHVZLWKVLOGHQDᚏODWOHDVW PRQWKVDIWHUFRPPHQFLQJLFL7KH*(4DVNHGಯKDVWKHPHGLFDWLRQ VLOGHQDᚏORULQMHFWLRQ JLYHQ\RXWKHDELOLW\WRDFKLHYHYDJLQDOSHQHWUDWLRQರ/RJLVWLFUHJUHVVLRQZDVXVHGWRGHᚏQH SUHGLFWRUVRIVLOGHQDᚏOUHVSRQVHRQUHFKDOOHQJH Results: 76 patients were included in this analysis. The mean age and ED duration ZHUH s \HDUV DQG s \HDUV &RPRUELGLW\ SURᚏOH LQFOXGHG K\SHUWHQVLRQ hyperlipidemia 18%, diabetes 14%, coronary artery disease 12%, radical prostatectomy %0,!FLJDUHWWHVPRNLQJKLVWRU\ FXUUHQWRUSDVW ZLWKDPHDQSDFN\HDU H[SRVXUHLQWKLVJURXSRIs$OOSDWLHQWVZHUHGHHPHGWRKDYHKDGDVXERSWLPDOUHVSRQVH WR VLOGHQDᚏO E\ VHOIUHSRUW ZLWK PHDQ SUH DQG SRVWVLOGHQDᚏO () GRPDLQ VFRUHV RI s DQGs,&,GXUDWLRQDWWLPHRIVLOGHQDᚏOUHFKDOOHQJHZDVsPRQWKV0HDQ()GRPDLQ VFRUHRQ,&,ZDVs VLOGHQDᚏOIDLOXUHVUHVSRQGHGWR,&,ZLWKSHQHWUDWLRQ KDUGQHVV 6LOGHQDᚏO UHFKDOOHQJH XVHG PJV RQ RFFDVLRQV ZHUH QRZ FDSDEOHRIVH[XDOLQWHUFRXUVHZLWKDUHFKDOOHQJH()GRPDLQVFRUHRIs,QWKHPHQZKR ZHUHVDOYDJHGWKH()'URVHIURPsWRs3UHGLFWRUVRIIDLOXUHWRUHVSRQGWRVLOGHQDᚏO RQUHFKDOOHQJHZHUHGLDEHWHV 25 S FLJDUHWWHVPRNLQJH[SRVXUH!SDFN\HDUV 25 S %0,! 25 DQG53 25 S
<0.00 0.242 <0.00 0.008 0.199 <0.00 0.411 0.001 0.859 <0.00 0.106 <0.00 0.471
Conclusions: 7KH HUHFWLOH IXQFWLRQ RI SDWLHQWV LQ 70*( JURXS ZDV VLJQLᚏFDQWO\ LPSURYHG 7LVVXH FXOWXUHG mountain ginseng extract might be useful as alternative agent for improving erectile function in male patients with erectile dysfunction
O9
Memorial Sloan-Kettering Cancer Centre and Weill Medical College of Cornell University, New York, United States of America
Conclusions: We have demonstrated that approximately one quarter of men who fail PDE5i can be salvaged by the use of intracavernosal injection, especially if they are not diabetic, obese, a cigarette smoker or have not had RP.
TREATMENT OF ADVANCED STAGE BLADDER AND UPPER URINARY TRACT CANCER
Thursday, 27 March, 15.45-17.15, Gold Hall
595
596
ARE COMORBIDITIES INDEXES ADEQUATE AND RELIABLE IN DETAILING MEDICAL SEVERITY IN PATIENTS UNDERGOING RADICAL CYSTECTOMY. A 10-YEAR TIME FRAME EXPERIENCE
TRANSURETHRAL LAYER SECTION OF MUSCLE INVASIVE BLADDER CANCER: ACCURATE T-STAGING AND BLADDER PRESERVATION IN A SELECTED T2 BLADDER CANCER
Salonia A.S., Maccagnano M.C., Gallina G.A., Colombo C.R., Da Pozzo D.L., Zanni Z.G., Rocchini R.L., Tutolo T.M., Camerota C.T., Rigatti R.P., Montorsi M.F.
Lee J.S.1, Choi Y.D.2, Cho K.S.2, Ham W.S.2, Cho N.H., Kim W.T.2 1
8QLYHUVLW\9LWD6DOXWH6DQ5DᚎDHOH'HSWRI8URORJ\0LODQ,WDO\ Introduction & Objectives: To assess whether widely used comorbidity indexes indices can be adequate and reliable in detailing medical severity in urologic patients undergoing radical cystectomy (RC) performed for muscle-invasive bladder cancer (MIBC) over 10 years at the same academic institution. Material & Methods: We reviewed all clinical records of n=51 and n=70 consecutive patients who underwent RC for MIBC in either 1996 (group 1) or 2006 (group 2), respectively. For study SXUSRVHV WKH WZR JURXSV ZHUH FRPSDUHG IRU SDWLHQWVಬ SUHRSHUDWLYH FKDUDFWHULVWLFV >LH DJH medical history, Body Mass Index (BMI), Charlson Comorbidity index (CCI), European System for Cardiac Operative Risk Evaluation (EuroSCORE), American Society of Anesthesiologists $6$ SK\VLFDO VWDWXV@ DQG SRVWRSHUDWLYH RXWFRPH GDWD >LH QXPEHU RI SHULVXUJHU\ PHGLFDO and surgery-requiring complications, number of transfusions until the hospital discharge]. The VWDWLVWLFDOVLJQLᚏFDQFHRIGLᚎHUHQFHVLQPHDQVDQGSURSRUWLRQVZHUHWHVWHGZLWKWZRWDLOHGWWHVW DQGWKHFKLVTXDUH ˴2) tests, respectively. Results: *URXSVZHUHFRPSDUDEOHLQWHUPVRIPHDQs6'DJH LHJURXSYVJURXS s YVs \U3 %0, s YVsNJP23 &KDUOVRQ,QGH[ s YV s 3 (XUR6&25( s YV s 3 DQG $6$ SK\VLFDO VWDWXV s YVs3 $JUHDWHUSURSRUWLRQRIJURXSSDWLHQWVVXᚎHUHGIURPK\SHUWHQVLRQ YV ˴2 3 DQGFKURQLFDWULDOᚏEULOODWLRQ YV ˴2 3 DV compared with group 1 patients. Likewise, a higher proportion of group 2 patients did use either ZDUIDULQRUDQWLDJJUHJDQWWKHUDS\ YV ˴2=4.5, P=0.02). Types of urinary diversion VLJQLᚏFDQWO\FKDQJHGRYHUWKHGHFDGH QDPHO\XUHWHURVLJPRLGRVWRP\LQ YV LOHDO FRQGXLWDFFRUGLQJWR%ULFNHULQYV XUHWHURFXWDQHRVWRP\LQYV DQG RUWKRWRSLF QHREODGGHU LQ YV 3 3URSRUWLRQV RI SHUL DQG SRVWRSHUDWLYH FRPSOLFDWLRQV UHTXLULQJ VXUJLFDO UHGR JURXS YV JURXS YV ˴2 3 DQGRISDWLHQWVZKRSRVWRSHUDWLYHO\GLHG YV ˴2 3 ZHUHVLPLODUEHWZHHQ JURXSV,QFRQWUDVWJURXSSDWLHQWVKDGDVLJQLᚏFDQWO\JUHDWHUUDWHRIFRPSOLFDWLRQVZKLFKQRW UHTXLUHGVXUJHU\ LHGHHSYHQRXVWKURPERVLVGHQRYRDWULDOᚏEULOODWLRQHLWKHUDQWLELRWLFWKHUDS\ SHUVLVWLQJ KLJK WHPSHUDWXUH RU VHSVLV GLᚑFXOWWREHFRQWUROOHG K\SHUWHQVLRQ HWF YV ˴2 3 6LPLODUO\SRVWRSHUDWLYHKRVSLWDOVWD\ZDVVLJQLᚏFDQWO\ORQJHUIRUJURXS SDWLHQWV s YVs G3 Conclusions: Although patients medical conditions at baseline were similar in the two groups we observed a 10-yr time frame increase in terms of clinical severity of MIBC patients undergoing RC thus requiring a greater postoperative medical care and a longer hospital stay.
Kwandong University College of Medicine, Dept. of Urology, Goyang, South Korea, Yonsei University College of Medicine, Dept. of Urology and Urological Science Institute, Seoul, South Korea, Yonsei University College of Medicine, Dept. of Pathology, Seoul, South Korea
2
Introduction & Objectives: We evaluated the feasibility of transurethral layer section of muscle bladder tumour (TULSB) for T staging and the outcomes of bladder preservation by TULSB in T2 muscle-invasive bladder cancer without chemotherapy or radiotherapy. Material & Methods: From 1997, 497 patients in whom an invasive is suspected were treated by TULSB. For TULSB, main tumour was completely removed with TURB (transurethral resection of bladder tumour) and then additional successive resection RI PRUH WKDQ PXVFOH OD\HUV ZDV VHULDOO\ SHUIRUPHG XQWLO SHULYHVLFDO DGLSRVH WLVVXH ZDV VDPSOHG %ODGGHU SUHVHUYDWLRQ ZDV OLPLWHG WR SDWLHQWV ZLWK VHULDO FRQᚏUPDWLRQ RI tumour negativity on additional resection layers below tumour base. Among the patients, SDWLHQWVZLWK7PXVFOHLQYDVLYHEODGGHUFDQFHUFRQᚏUPHGE\78/6%ZHUHHQUROOHGIRU bladder preservation protocol without chemotherapy or radiation therapy. Median followXSGXUDWLRQZDV PRQWKV Results: Among the patients in whom an invasive is suspected were treated by TULSB, T stage were consisted of 260 patients in T1, 118 patients in T2, and 119 patients in PRUHWKDQ7,Q SDWLHQWVUDGLFDOF\VWHFWRP\ZDVGRQHDIWHU78/6%GXHWRSDWLHQWಬV no consent. In cystectomy specimens, all had no residual muscle invasive tumour in EODGGHU%XW SDWLHQWVVKRZHGWKHUHVLGXDOVXSHUᚏFLDOFDQFHUDQGSDWLHQWVVKRZHG the carcinoma in situ. Of 99 patients with T2 muscle invasive bladder cancer treated with only TULSB were enrolled for bladder preservation, 57 patients (57.6%) showed no UHFXUUHQFHEXWSDWLHQWV H[SHULHQFHGEODGGHUUHFXUUHQFHSDWLHQWVVKRZHG WKH VXSHUᚏFLDO UHFXUUHQFH WKDW ZDV WUHDWHG ZLWK 78/6% SDWLHQWV VKRZHG progression and were treated with cystectomy and chemotherapy. 5 patients died of GLVHDVH\HDUGLVHDVHVSHFLᚏFVXUYLYDOUDWHZDV Conclusions: TULSB can select the T2 muscle-invasive bladder cancer among the patients in whom an invasive is suspected. In selective T2 muscle invasive bladder FDQFHU EODGGHU FDQ EH SUHVHUYHG E\ WUDQVXUHWKUDO OD\VHFWLRQ FRQᚏUPDWLRQ RI WXPRXU negativity without chemotherapy or radiation therapy.
Eur Urol Suppl 2008;7(3):219