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UP-1.053: Endoscopic Management of Ureterovesical Anastomosis Obstruction in Transplanted Kidneys
UNMODERATED POSTER SESSIONS
ment ratio of percutaneous nephropunctura and the calculus removed ratio in mPCNL.
UP-1.050 The Influence of Retroperitoneal Laparoscopic Surgery on the Human Immunoglobulins, Complements, CReactive Protein ad Expression of ET1 in Renal Tissue Fan T, Liu Y Department of Urology, West China Hospital, Sichuan University, Chengdu, China Introduction and Objective: To study the influence of retroperitoneal laparoscopic surgery (RLS) and open surgery (OS) on humoral immune and renal stress responses. Materials and Methods: The changes in humoral immune responses were compared in patients underwent retroperitoneal laparoscopic surgery with open surgery. Immune parameters including serum immunoglobulins( IgG, IgA, IgM), complements (C3, C4) and C-reactive protein(CRP) were assessed at preoperation, intraoperation and 24 hours postoperation. The expression intensity of Endothelin1(ET-1) in renal tissue was detected with immunohistochemistry. Results: The levels of serum immunoglobulins and complements did not change after RLS (P⬎0.05), but the levels of serum IgG and C3 significantly decreased after OS (P ⬍ 0.01). There was no significant difference between two groups. The levels of serum CRP obviously increased in RLS and OS, but the change in the OS group was obviously higher than that in the RLS group. There was a significant difference between two groups (P ⬍ 0.01). The proportion of Endothelin-1(ET-1) positive cells in renal tissue was higher in the OS group than in the RLS group, but there was no significant difference between two groups (P⬎0.05). Conclusions: Both RLS and OS can cause some depression of immune function in the earlier postoperative period. But RLS causes less depression of immune function than OS does. That means the retroperitoneal laparoscopic surgery is less traumatic.
UP-1.051 Development of a New Surgical Glue in Laparoscopic Partial Nephrectomy Naitoh Y, Kawauchi A, Soh J, Okihara K, Miki T Department of Urology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
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Introduction and Objective: A new surgical glue developed using food additives was examined for its hemostatic effect in partial nephrectomy. Materials and Methods: The new surgical glue is made from food additives. Experimental rabbits (mean body weight: 4 kg) were used in this study. The renal artery-vein was clamped with vessel tape to block renal blood flow and partial nephrectomy was performed. In all experiments, the section sizes were adjusted so as to be almost equal. It was confirmed that the renal calices remained open to evaluate urine leakage. Hemostasis was performed using a new surgical glue in group A (n⫽10) and fibrin glue in group B (n⫽10). In group C (n⫽10), no hemostatic treatment was performed. In both groups A and B, after the hemostatic treatment was completed, the renal blood flow was blocked for two minutes, and then the blood loss was measured once the blockage was eliminated. The blood loss was measured for seven minutes. The resected areas were evaluated macroscopically and histologically after seven days and after one month. Results: Hemorrhage was stopped within 7 minutes in groups A and B. Mean blood loss was 1.45 g in group A, 6.59 g in group B and 19.77 g in group C, and blood loss was significantly less in group A than in groups B and C (p⬍0.001). After 7 days in group A, Neither hematoma nor any trace of urine leakage was observed around the resection stump. There was no evidence of infection. After 7 days in group B, hematoma was observed at the resection stump. After one month in group A, Adhesions with the surrounding organs were not observed. Most of a new surgical glue had degraded. Conclusions: A new surgical glue showed superior hemostatic control in the stump of a partial nephrectomy. Compared to glues such as fibrin glue, it does not have the problems associated with blood derivatives such as infection, and it may be useful in hemostasis of the stump in partial nephrectomy because of its superior degradation.
Introduction and Objective: Urethral strictures (US), impassable in a retrograde fashion, impose a special problem to the urologist. Open urethroplasty is usually required. Our goal was to evaluate the results of bipolar endoscopic procedures (BEP) in such cases. Materials and Methods: Between November 1999 and January 2009, we evaluated 42 patients with complicated urethral strictures (5 penian, 24 bulbar and 13 membranous) which have been treated by BEP. 28 cases had perineal urethral trauma, 12 cases had recurrent inflammatory stenosis and 2 cases had previous prostatic surgery. All cases underwent previous suprapubic cystostomy. In 34 cases, we used the “cut-to-light” technique (flexible cystoscope introduced antegradely), and in 8 cases the incision was made over the guidewire placed in an antegrade manner (23 cases with cold-knife and 19 cases with Nd:YAG laser). The mean follow-up period was 58 months. Results: In 39/42 patients (92.9%), the procedure was successfully carried out. However, the global recurrence rate was 53.8% (21/39 cases), imposing further endoscopic management in order to maintain urethral patency. Regarding the location of the stricture, the recurrence rate was: 50% for penile, 47.8% for bulbar and 66.7% for membranous urethra. The recurrence rate was 65.2% (15/21 cases) for patients treated by cold-knife incision by comparison to 33.3% (6/18 cases) in those treated with Nd:YAG laser. The mean recurrence period was 11 months. Conclusion: BEP, performed especially by the “cut-to-light technique”, represents an alternative for complete urethral stenosis. This method may constitute the firstchoice treatment alternative, especially for severe strictures of the bulbar urethra.
UP-1.052 Ten Years Experience with Bipolar Approach in Complete Urethral Strictures Georgescu D, Multescu R, Cauni V, Geavlete B, Geavlete P Department of Urology, “Saint John” Emergency Clinical Hospital, Bucharest, Romania
Introduction and Objective: Ureterovesical anastomosis obstruction in transplanted kidneys remains challenge to urologist. The complicated adjacent anatomy and high risk to infection was the disadvantage to open operation reconstruction. We reported our experience of endoscopic management for these cases. Material and Methods: Between Octo-
UP-1.053 Endoscopic Management of Ureterovesical Anastomosis Obstruction in Transplanted Kidneys Zeng G, Zhong W, Li X, Yuan J, Yang H, Chen W Department of Urology, The First Affiliated Hospital of Guangzhou Medical College, Guangzhou, China
UROLOGY 74 (Supplment 4A), October 2009
UNMODERATED POSTER SESSIONS
ber 2000 and July 2007, 5 men and 2 women with ureterovesical anastomotic obstruction in their transplanted kidneys were treated. An antergrade percutaneous approach was adopted when retrograde approach failed. Percutaneous nephrostomy was carried following a nephrograph from the mini punctue with 25G transfixion pin, which inserted into the renal collecting system with the assistance of ultrasonography firstly, and the final tract was dilated only to 14-16Fr, a 8/9.8Fr rigid ureteroscope was used then. Following a initially incision by electrosurgical unit, the obstructive junction was completely dilated by balloon dilator under the guidance of a 0.035Inch guide wire. Two 5F Double-J stents were indewelled for 6-8 weeks. Results: All endoscopic procedures was successful. Mean operating time was 101 minutes. Only 1 case was completed retrograded and was dilated by fasical dilators; 6 cases received nephrostomy and antergrade management. Of these 6 cases, 2 cases had simplex balloon dilation and 4 cases had an incision by electrosurgical unit before the ballon dilation. In a mean follow-up of 21 months, 6 cases had urteral patency and stable renal function. One case with recurred obstruction underwent open surgical correction. Conclusion: Endoscopic management of ureterovesical anastomosis obstruction in transplanted kidneys was safe and effective; it can be the first choice for theses cases. UP-1.054 Preliminary Study of TissueEngineered Lingual Mucosa Reconstruction Hu X1, Xu Y1, Li C1, Fu Q1, Song L2, Cui L 1 Department of Urology, Sixth People’s Hospital, Shanghai Jiaotong University, Shanghai, China; 2Shanghai Tissue Engineering Development and Research Center, Shanghai, China Introduction and Objective: To investigate the feasibility of tissue-engineered mucosa reconstruction using lingual mucosa cells seeded on bladder acellular matrix graft (BAMG). Materials and Methods: Rabbit lingual mucosa cells were isolated and seeded onto a culture dish. Lingual mucosa cells were observed by inverted phase contrast microscope since the second day after seeding for morphologic change and growth condition. The quantity of lingual mucosa cell was counted using cell counting meter and the cell growth curve was
drawn and immunofluorescence staining with broad-spectrum keratin antibody was carried out. The bladder taken from variant male rabbit of homogeneity was decelluled, made into BAMG and HE staining was carried out randomly to observe the effect of acellularization. Passage 2 Lingual mucosa cells were applied to sterilized BAMG to obtain a tissue-engineered mucosa. The tissue-engineered mucosa was assessed using HE staining and scanning electron microscope. Results: Lingual mucosa cells could be passaged for 4 or 5 generations. Lingual mucosa cells started logarithmic growth at 8th day and reached the peak value at 14th day. Lingual mucosa cells manifested green color fluorescence. After the cells were removed, the BAMG we got presented as a porous membrane. Through HE staining randomly we found that the effect of acellularization was fine and there were no cells at all. Passage 2 Lingual mucosa cells were expanded and seeded onto sterilized BAMG to obtain a tissue-engineered mucosa. Fine biocompatibility of the compound graft was assessed using HE staining and scanning electron microscope. Conclusions: Lingual mucosa cells of rabbit can be cultured in vitro and attain magnitude quantity. Lingual mucosa cells also had fine biocompatibility with BAMG and the compound graft could be a new material choice used for urethral reconstruction. UP-1.055 Nerve-Sparing Laparoscopic Radical Prostatectomy (Report on 56 Cases) Gao X, Liu X, Zhou X, Cai Y, Qiu J, Wen X, Si-tu J, Zhan H, Huang W Urology Department, the Third Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China Introduction and Objective: To evaluate the effect of nerve-sparing laparoscopic radical prostatectomy (NSLRP) on the postoperative quality of life. Materials and Methods: Between February 2001 and July 2007, we performed LRP on 245 patients with localized prostate cancer (PCa). Of them, 56 patients with preoperative erectile function (IIEF5 scores range from 16 to 24) and indications (PSA⬍10ng/ml; Gleason scores⬍7; Age⬍70 years old) underwent NSLRP. Among them, 39 cases had bilateral NSLRP, and 17 cases had unilateral NSLRP. Briefly, the key steps of the technique as following: opened the Denonvillier’s fascia and dissected posterior wall of prostate; raised the bilateral seminal vesi-
UROLOGY 74 (Supplment 4A), October 2009
cles and exposed the bilateral ligaments of prostate; prostate pedicle was dissected outside of the base of seminal vesicle and cut off close to the prostate capsular with hemo-lock or ultrasound knife. Then opened pelvic levator ani fascia longitudinally from the lateral of the prostate lateral, the lateral prostate ligament was dissected longitudinally above the neurovascular bundles using ultrasound knife, or ligated with Hemo-lock discontinuously and then cut off in the same way. Dissociated the urethra at the apex of prostate and avoided the damage of cavernous nerves which go into the urethra at 5 and 7 o’clock. After surgery, continually low dose of PDE5 inhibitor therapy, intracavernous injection or vacuum constriction devices was performed for 3 months to restore the function of penis at the early stage. The patients’ erectile function and urinary control were evaluated one year after the surgery. Results: About 69% patients who had NSLRP preserved sexual function 1 year after the surgery, in which 50% (28/56) of patients engage in intercourse with the assistance of PDE5 inhibitor, IIEF5 scores 0-7 in 20%(11/56), 8-11 in 32%(18/56), 13-21 in 41%(23/56), 22-25 in 7%(4/56), respectively. Urinary control rate at 6 and 12 months after the surgery were 92% and 99.5%, respectively. Conclusions: The NSLRP could effectively preserve the most of the patients’ sexual function and enhance the early recovery of erectile function and urinary continence. After the surgery, using low dose of PDE5 inhibitor at early stage could benefit the early recovery of erectile function. UP-1.056 Comparative Study of Standard and Mini-Perc Renal Access in Percutaneous Nephrolithotomy Guo J, Wang G, Xu Z Dept. of Urology, Zhongshan Hospital, Fudan University, Shanghai, China Introduction and Objective: To compare the efficacy and safety of standard and mini-perc renal access in percutaneous nephrolithotomy. Materials and Methods: From Feb 2006 to Jan 2008, 200 patients were enrolled into two procedures, standard or miniPCNL. The parameter of the two groups included the number of the patients, stone burdens and types were statistically showed no different. The types of the stone were pelvic, multiple, partial staghorn, complete staghorn, caliceal diverticular, ureteral, etc. we compared the ac-
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ment ratio of percutaneous nephropunctura and the calculus removed ratio in mPCNL.
UP-1.050 The Influence of Retroperitoneal Laparoscopic Surgery on the Human Immunoglobulins, Complements, CReactive Protein ad Expression of ET1 in Renal Tissue Fan T, Liu Y Department of Urology, West China Hospital, Sichuan University, Chengdu, China Introduction and Objective: To study the influence of retroperitoneal laparoscopic surgery (RLS) and open surgery (OS) on humoral immune and renal stress responses. Materials and Methods: The changes in humoral immune responses were compared in patients underwent retroperitoneal laparoscopic surgery with open surgery. Immune parameters including serum immunoglobulins( IgG, IgA, IgM), complements (C3, C4) and C-reactive protein(CRP) were assessed at preoperation, intraoperation and 24 hours postoperation. The expression intensity of Endothelin1(ET-1) in renal tissue was detected with immunohistochemistry. Results: The levels of serum immunoglobulins and complements did not change after RLS (P⬎0.05), but the levels of serum IgG and C3 significantly decreased after OS (P ⬍ 0.01). There was no significant difference between two groups. The levels of serum CRP obviously increased in RLS and OS, but the change in the OS group was obviously higher than that in the RLS group. There was a significant difference between two groups (P ⬍ 0.01). The proportion of Endothelin-1(ET-1) positive cells in renal tissue was higher in the OS group than in the RLS group, but there was no significant difference between two groups (P⬎0.05). Conclusions: Both RLS and OS can cause some depression of immune function in the earlier postoperative period. But RLS causes less depression of immune function than OS does. That means the retroperitoneal laparoscopic surgery is less traumatic.
UP-1.051 Development of a New Surgical Glue in Laparoscopic Partial Nephrectomy Naitoh Y, Kawauchi A, Soh J, Okihara K, Miki T Department of Urology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
S186
Introduction and Objective: A new surgical glue developed using food additives was examined for its hemostatic effect in partial nephrectomy. Materials and Methods: The new surgical glue is made from food additives. Experimental rabbits (mean body weight: 4 kg) were used in this study. The renal artery-vein was clamped with vessel tape to block renal blood flow and partial nephrectomy was performed. In all experiments, the section sizes were adjusted so as to be almost equal. It was confirmed that the renal calices remained open to evaluate urine leakage. Hemostasis was performed using a new surgical glue in group A (n⫽10) and fibrin glue in group B (n⫽10). In group C (n⫽10), no hemostatic treatment was performed. In both groups A and B, after the hemostatic treatment was completed, the renal blood flow was blocked for two minutes, and then the blood loss was measured once the blockage was eliminated. The blood loss was measured for seven minutes. The resected areas were evaluated macroscopically and histologically after seven days and after one month. Results: Hemorrhage was stopped within 7 minutes in groups A and B. Mean blood loss was 1.45 g in group A, 6.59 g in group B and 19.77 g in group C, and blood loss was significantly less in group A than in groups B and C (p⬍0.001). After 7 days in group A, Neither hematoma nor any trace of urine leakage was observed around the resection stump. There was no evidence of infection. After 7 days in group B, hematoma was observed at the resection stump. After one month in group A, Adhesions with the surrounding organs were not observed. Most of a new surgical glue had degraded. Conclusions: A new surgical glue showed superior hemostatic control in the stump of a partial nephrectomy. Compared to glues such as fibrin glue, it does not have the problems associated with blood derivatives such as infection, and it may be useful in hemostasis of the stump in partial nephrectomy because of its superior degradation.
Introduction and Objective: Urethral strictures (US), impassable in a retrograde fashion, impose a special problem to the urologist. Open urethroplasty is usually required. Our goal was to evaluate the results of bipolar endoscopic procedures (BEP) in such cases. Materials and Methods: Between November 1999 and January 2009, we evaluated 42 patients with complicated urethral strictures (5 penian, 24 bulbar and 13 membranous) which have been treated by BEP. 28 cases had perineal urethral trauma, 12 cases had recurrent inflammatory stenosis and 2 cases had previous prostatic surgery. All cases underwent previous suprapubic cystostomy. In 34 cases, we used the “cut-to-light” technique (flexible cystoscope introduced antegradely), and in 8 cases the incision was made over the guidewire placed in an antegrade manner (23 cases with cold-knife and 19 cases with Nd:YAG laser). The mean follow-up period was 58 months. Results: In 39/42 patients (92.9%), the procedure was successfully carried out. However, the global recurrence rate was 53.8% (21/39 cases), imposing further endoscopic management in order to maintain urethral patency. Regarding the location of the stricture, the recurrence rate was: 50% for penile, 47.8% for bulbar and 66.7% for membranous urethra. The recurrence rate was 65.2% (15/21 cases) for patients treated by cold-knife incision by comparison to 33.3% (6/18 cases) in those treated with Nd:YAG laser. The mean recurrence period was 11 months. Conclusion: BEP, performed especially by the “cut-to-light technique”, represents an alternative for complete urethral stenosis. This method may constitute the firstchoice treatment alternative, especially for severe strictures of the bulbar urethra.
UP-1.052 Ten Years Experience with Bipolar Approach in Complete Urethral Strictures Georgescu D, Multescu R, Cauni V, Geavlete B, Geavlete P Department of Urology, “Saint John” Emergency Clinical Hospital, Bucharest, Romania
Introduction and Objective: Ureterovesical anastomosis obstruction in transplanted kidneys remains challenge to urologist. The complicated adjacent anatomy and high risk to infection was the disadvantage to open operation reconstruction. We reported our experience of endoscopic management for these cases. Material and Methods: Between Octo-
UP-1.053 Endoscopic Management of Ureterovesical Anastomosis Obstruction in Transplanted Kidneys Zeng G, Zhong W, Li X, Yuan J, Yang H, Chen W Department of Urology, The First Affiliated Hospital of Guangzhou Medical College, Guangzhou, China
UROLOGY 74 (Supplment 4A), October 2009
UNMODERATED POSTER SESSIONS
ber 2000 and July 2007, 5 men and 2 women with ureterovesical anastomotic obstruction in their transplanted kidneys were treated. An antergrade percutaneous approach was adopted when retrograde approach failed. Percutaneous nephrostomy was carried following a nephrograph from the mini punctue with 25G transfixion pin, which inserted into the renal collecting system with the assistance of ultrasonography firstly, and the final tract was dilated only to 14-16Fr, a 8/9.8Fr rigid ureteroscope was used then. Following a initially incision by electrosurgical unit, the obstructive junction was completely dilated by balloon dilator under the guidance of a 0.035Inch guide wire. Two 5F Double-J stents were indewelled for 6-8 weeks. Results: All endoscopic procedures was successful. Mean operating time was 101 minutes. Only 1 case was completed retrograded and was dilated by fasical dilators; 6 cases received nephrostomy and antergrade management. Of these 6 cases, 2 cases had simplex balloon dilation and 4 cases had an incision by electrosurgical unit before the ballon dilation. In a mean follow-up of 21 months, 6 cases had urteral patency and stable renal function. One case with recurred obstruction underwent open surgical correction. Conclusion: Endoscopic management of ureterovesical anastomosis obstruction in transplanted kidneys was safe and effective; it can be the first choice for theses cases. UP-1.054 Preliminary Study of TissueEngineered Lingual Mucosa Reconstruction Hu X1, Xu Y1, Li C1, Fu Q1, Song L2, Cui L 1 Department of Urology, Sixth People’s Hospital, Shanghai Jiaotong University, Shanghai, China; 2Shanghai Tissue Engineering Development and Research Center, Shanghai, China Introduction and Objective: To investigate the feasibility of tissue-engineered mucosa reconstruction using lingual mucosa cells seeded on bladder acellular matrix graft (BAMG). Materials and Methods: Rabbit lingual mucosa cells were isolated and seeded onto a culture dish. Lingual mucosa cells were observed by inverted phase contrast microscope since the second day after seeding for morphologic change and growth condition. The quantity of lingual mucosa cell was counted using cell counting meter and the cell growth curve was
drawn and immunofluorescence staining with broad-spectrum keratin antibody was carried out. The bladder taken from variant male rabbit of homogeneity was decelluled, made into BAMG and HE staining was carried out randomly to observe the effect of acellularization. Passage 2 Lingual mucosa cells were applied to sterilized BAMG to obtain a tissue-engineered mucosa. The tissue-engineered mucosa was assessed using HE staining and scanning electron microscope. Results: Lingual mucosa cells could be passaged for 4 or 5 generations. Lingual mucosa cells started logarithmic growth at 8th day and reached the peak value at 14th day. Lingual mucosa cells manifested green color fluorescence. After the cells were removed, the BAMG we got presented as a porous membrane. Through HE staining randomly we found that the effect of acellularization was fine and there were no cells at all. Passage 2 Lingual mucosa cells were expanded and seeded onto sterilized BAMG to obtain a tissue-engineered mucosa. Fine biocompatibility of the compound graft was assessed using HE staining and scanning electron microscope. Conclusions: Lingual mucosa cells of rabbit can be cultured in vitro and attain magnitude quantity. Lingual mucosa cells also had fine biocompatibility with BAMG and the compound graft could be a new material choice used for urethral reconstruction. UP-1.055 Nerve-Sparing Laparoscopic Radical Prostatectomy (Report on 56 Cases) Gao X, Liu X, Zhou X, Cai Y, Qiu J, Wen X, Si-tu J, Zhan H, Huang W Urology Department, the Third Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China Introduction and Objective: To evaluate the effect of nerve-sparing laparoscopic radical prostatectomy (NSLRP) on the postoperative quality of life. Materials and Methods: Between February 2001 and July 2007, we performed LRP on 245 patients with localized prostate cancer (PCa). Of them, 56 patients with preoperative erectile function (IIEF5 scores range from 16 to 24) and indications (PSA⬍10ng/ml; Gleason scores⬍7; Age⬍70 years old) underwent NSLRP. Among them, 39 cases had bilateral NSLRP, and 17 cases had unilateral NSLRP. Briefly, the key steps of the technique as following: opened the Denonvillier’s fascia and dissected posterior wall of prostate; raised the bilateral seminal vesi-
UROLOGY 74 (Supplment 4A), October 2009
cles and exposed the bilateral ligaments of prostate; prostate pedicle was dissected outside of the base of seminal vesicle and cut off close to the prostate capsular with hemo-lock or ultrasound knife. Then opened pelvic levator ani fascia longitudinally from the lateral of the prostate lateral, the lateral prostate ligament was dissected longitudinally above the neurovascular bundles using ultrasound knife, or ligated with Hemo-lock discontinuously and then cut off in the same way. Dissociated the urethra at the apex of prostate and avoided the damage of cavernous nerves which go into the urethra at 5 and 7 o’clock. After surgery, continually low dose of PDE5 inhibitor therapy, intracavernous injection or vacuum constriction devices was performed for 3 months to restore the function of penis at the early stage. The patients’ erectile function and urinary control were evaluated one year after the surgery. Results: About 69% patients who had NSLRP preserved sexual function 1 year after the surgery, in which 50% (28/56) of patients engage in intercourse with the assistance of PDE5 inhibitor, IIEF5 scores 0-7 in 20%(11/56), 8-11 in 32%(18/56), 13-21 in 41%(23/56), 22-25 in 7%(4/56), respectively. Urinary control rate at 6 and 12 months after the surgery were 92% and 99.5%, respectively. Conclusions: The NSLRP could effectively preserve the most of the patients’ sexual function and enhance the early recovery of erectile function and urinary continence. After the surgery, using low dose of PDE5 inhibitor at early stage could benefit the early recovery of erectile function. UP-1.056 Comparative Study of Standard and Mini-Perc Renal Access in Percutaneous Nephrolithotomy Guo J, Wang G, Xu Z Dept. of Urology, Zhongshan Hospital, Fudan University, Shanghai, China Introduction and Objective: To compare the efficacy and safety of standard and mini-perc renal access in percutaneous nephrolithotomy. Materials and Methods: From Feb 2006 to Jan 2008, 200 patients were enrolled into two procedures, standard or miniPCNL. The parameter of the two groups included the number of the patients, stone burdens and types were statistically showed no different. The types of the stone were pelvic, multiple, partial staghorn, complete staghorn, caliceal diverticular, ureteral, etc. we compared the ac-
S187