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UP-3.022: Timing of Complications after Radical Cystectomy for Bladder Cancer
UNMODERATED POSTER SESSIONS
ease specific survival and recurrence free survival were investigated by Kaplan-Meier analysis and Cox proportional hazards analysis in multivariate model and correlated with variables such as tumor stage, growth pattern, clinical outcome (recurrence and survival). In vitro, Nurr1 was examined for its role in bladder cancer cell proliferation and migration using siRNA silencing. Results: Nurr1 expression in tumor cells correlated with increasing tumor stage and invasive growth pattern. Disease specific survival was significantly shorter in patients whose tumors showing a high level of cytoplasmic Nurr1 compared to those with lower levels of cytoplasminc Nurr1 expression. Furthermore, cytoplasmic Nurr1 expression level was an independent predictor of diesease specific survival (odds ratio 4.894 and p ⬍ 0.001). In vitro, silencing of endogenous Nurr1 attenuated the migration of bladder cancer cells. Conclusions: The expression of Nurr1 in the cytoplasm correlates with adverse outcome and is a independent prognostic marker for tumor progression and survival in patients with bladder cancer. This might represent a novel target in bladder cancer therapy.
UP-3.018 Telomerase Activity in Bilharzial Squamous Cell Carcinoma of the Bladder Hassouna M1, Ibtessam R2, Samia E2 1 Dept. of Urology, Faculty of Medicine, Alexandria University, Alexandria, Egypt; 2Medical Research Institute, Alexandria, Egypt Introduction and Objective: The clinicopathologic pattern of Bilharzial bladder cancer differs than that of T C C. Telomerase activity in such tumors was evaluated. Materials and Methods: Thirty patients with Sq c c and 30 controls were included in this study for RT-PCR of telomerase. Results: Telomerase sensitivity in Sq cell carcinoma was 94.7%. A low specificity rate of only 66% was detected. Conclusions: Telomerase activity shows a higher sensitivity in Bilharzial sq. c.c. than that of T.C.C. of the bladder. The sensitivity of that test is much lower than previously detected in the literature. The high false positive rates greatly limit the use of this test.
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UP-3.019 Bladder Tumors in Young People Minciu R, Boiborean P, Daminescu L Department of Urology, University of Medicine and Pharmacy “V.Babes”, Timisoara, Romania Introduction and Objective: Cancers are considered to be more aggressive in young people. We wanted to evaluate this statement in case of bladder cancer. Materials and Methods: In a period of four years, we diagnosed 39 new cases of bladder cancer in patients younger than 50 years. These patients were divided in two groups: Group A – patients younger than 40 years (7 cases) and group B- patients between 40 and 50 years (32 cases). Males were more frequent than females in both groups: M/F ⫽ 2.5 in group A and more evident in group B, M/F⫽7. Results: All tumors in group A were superficial non muscle invasive (Ta, T1). In group B most of the tumors were superficial (62.5%), but muscle invasive tumors were also diagnosed (37.5%). All tumors in group A were low graded, while in group B high grade tumors were also diagnosed (12.5%). None of the patients under 30 years encountered recurrence during follow up and only 2 patients between 30 and 40 years were operated again for same T and G recurrence. Conclusions: Bladder malignant tumors in young people (under 40 years) have a low agressivity: they are superficial and low grade tumors. Tumors in patients between 40 and 50 years have the same characteristics as in older people (over 50 years). UP-3.020 Recurrence Rates after Photodynamic Cystoscopic Resection of TCC Bladder Nair R, Shaw G, Schaerf D, Nitkunen T, Bunce C Barnet & Chase Farm Hospitals NHS Trust, London, United Kingdom Introduction and Objective: Photodiagnostic cystoscopy utilizes Hexa ALA instilled into the bladder pre-operatively to assist in the detection of transitional cell carcinomas and carcinoma in situ which might be missed on conventional white light cystoscopy. This chemical renders the abnormal mucosa red when visualized under blue light thereby making the lesions more easily detectable than under white light. TURBT performed using photodynamic therapy allows the surgeon to check the completeness of the resection and visualize flat/small tumours not easily seen under white light alone. Materials and Methods: The case notes
of 71 patients newly diagnosed with nonmuscle invasive TCC bladder without CIS diagnosed at TURBT were identified. 24 patients had TURBT with photodynamic assistance. 47 had standard white light TURBT. The recurrence rates were analysed at follow up cystoscopy. Results: The recurrence rates were 15% vs 45% in the photodynamic assisted TURBT group and the standard TURBT groups respectively (p⬍0.05, t-test). The mean time to follow up cystoscopy was 4 months. The range was 0.93-9.74 months. The photodynamic group was composed of 18% G1, 52% G2 and 30% G3. The staging for this group was 78% pTa, 22% pT1. The standard group was composed of 27% G1, 54% G2 and 19% G3. The staging for this group was 89% pTa, 11% pT1. Three G3pT1 tumours were resected using in each group. In the photodynamic group no recurrence/residual tumour was seen at re-resection after an average of 3.12 months. In the standard light TURBT group 2 patients had further tumour resected at the second look TURBT after an average of 3 months. Conclusion: The use of photodynamic cystoscopy to identify TCC in patients newly diagnosed with TCC bladder would seem to result in lower rates of recurrence. Correct assessment of tumour grade and stage is particularly important in patients with G3pT1 disease. Hexa-ALA instillation is helpful in assisting in complete resection of tumours. UP-3.022 Timing of Complications after Radical Cystectomy for Bladder Cancer Thorstenson A, Jonsson M, Henningsohn L, Hosseini A, Wikjstrom H, Schumacher M, Wiklund P Department of Urology, Karolinska University Hospital, Stockholm, Sweden Introduction and Objective: To present the survival and time of occurrence of complications in patients who have undergone radical cystectomy and urinary diversion due to bladder cancer. Materials and Methods: A total of 148 patients underwent radical cystectomy and urinary diversion due to bladder cancer at the Karolinska University Hospital during 2000-2005. Twenty-four male patients underwent prostatic capsule and seminal sparing cystectomy and seven patients underwent robot assisted laparoscopic cystectomy. Lymph node dissections were performed in 63% of the patients. Ileal conduits were performed in 47%, continent cutaneous reservoirs in 3% and orthotopic neobladders in 50% of the patients.
UROLOGY 74 (Supplment 4A), October 2009
UNMODERATED POSTER SESSIONS
UP-3.022, Table 1. Type, Frequency and Time of Occurrence of Complications in the 148 Patients Who Underwent Cystectomy and Urinary Diversion Complication Day 1-30 Complication Day 30-90 Complication Day > 90 Total No. of Patients Type of Complication (No. of Patients) (No. of Patients) (No. of Patients) with Complications Urosepsis (positive urinary culture) 16 4 12 32 Wound infection 22 1 2 25 Renal failure (S-creatinine ⬎200 mol/L) 3 1 12 16 Sepsis (negative urinary culture) 12 3 0 15 Cutaneous fistula from bowel 7 2 2 11 Wound hernia 0 0 11 11 Parastomal hernia 0 0 10 10 Abscess 5 1 2 8 Strictured anastomosis between Wallace 0 0 7 7 plate and urinary diversion Intestinal perforation 5 0 1 6 Strictured anastomosis orthotopic 0 0 5 5 substitution-urethra Insufficient anastomosis between Wallace 4 0 0 4 plate and urinary diversion Stone in the urinary diversion 0 0 4 4 Non functioning uretery catheters and 3 0 0 3 subsequent nephrostomy tube Ureteric stone 0 1 0 1 Stenosis of cutaneous stoma 0 0 1 1 Total No. of patients with complications 77 13 69 159
Results: The 148 patients had an overall survival rate of 55% and a cancer-specific survival of 62% at five years. Three patients (2.1%) died in the early postoperative period (myocardial infarction, insufficient bowel anastomosis and aspiration pneumonia). We observed 159 complications. The type, frequency and time of occurrence of the complications are presented in the Table. Urosepsis was the most frequent complication and occurred in 32/148 patients (22%). The complications occurred more than 90 days after the operation in 69/159 patients (43%). Complications that commonly occurred more than 90 days after the radical cystectomy were: renal failure, hernia, strictures and stone in the urinary diversion. Conclusions: Patients who undergo radical cystectomy frequently suffer from various complications. Our data show that 43% of the complications occur more than 90 days after the operation, why long term data is necessary when discussing complications in this group of patients. UP-3.023 Five-Year Result of Cutaneous Catheterizable Continent Diversion with Extramural Supported Tapered Ileum Efferent Tube Zhang X, Xu X, Qiao Y, Wu D, Sa Y, Zhang J, Chen R Shanghai Jiaotong University Afilliated Shanghai 6th People’s Hospital, Shanghai, China
Introduction and Objective: To evaluate long-term clinical outcomes in patients who received cutaneous continent diversion (CCD) with extramural supported tapered ileum outlet. Materials and Methods: Eighty-four consecutive patients (63 male and 21 female, 6-78 year-old) received a CCD with extramural supported tapered ileum outlet operation in our hospital from October 1999 to July 2003. Two extramural supporting ways to enhance the tapered ileum outlet continent mechanism were used: 1. The tapered ileum was fixed to the back surface of the rectus muscle by using two 1-cm wide polyester tapers with a suspension tension of 500 gram in 39 patients. 2. An additional 5-cm ileal segment was placed between the back surface of the rectus muscle and the W-shaped ileal pouch wall in another 45 patients. The early and long term complications, re-operation rate and continent rate were followed. Results: One patient died due to heart disease 55 days after operation; 8 patients (9.6%) had early complications within 60 days postoperatively in which 2 (2.4%) patients received re-operation. Twentytwo patients (26.5%) had 23 long-term complications, of which 5 were related to outlet (2 in polyester tapers and 3 in additional ileal segment) and 5 patients (6.02%) received re-operation. Among 52 patients who were followed-up recently (61-91 months, average 66.3⫾4.03 months), 4 patients were not able to live
UROLOGY 74 (Supplment 4A), October 2009
a self-care life, 5 patients required detained duct, of which the reasons were varied from continent mechanism failure in 2 (each extramural supporting way had one), gradually serious celiodynia after reservoir volume exceed 100 ml in 1, refusing another operation to reshape the unilateral urethra reflux in 2. Other 48 patients could empty the reservoir by cleaning intermittent self-catheterization, continence was achieved in 43 patients (89.6%) and 37 were completely continent day and night (77.1%). Satisfied continence rate was achieved in 77.3% (17/ 22) and 76.9 % (20/26) of patients applying polyester tapers and additional ileal segment, respectively. Conclusions: Our data suggest that a stable, continuous and reliable continent ability could be obtained by tapered ileum outlet with extramural supported. Most of the complications of this procedure are mild and the re-operation rate is relatively low. UP-3.024 Outcome of Function with Studer Ileal Neobladder Replacement in Patients with Muscle Invasive Bladder Tumor (10 Years of Experience with 32 Cases) Mahdavi Zafarghandi R1, Arab D2, Shakibi M1, Mahdavi Zafarghandi M1 1 Department of Urology, Imam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, Iran; 2Mashhad University of Medical Sciences, Mashhad, Iran
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ease specific survival and recurrence free survival were investigated by Kaplan-Meier analysis and Cox proportional hazards analysis in multivariate model and correlated with variables such as tumor stage, growth pattern, clinical outcome (recurrence and survival). In vitro, Nurr1 was examined for its role in bladder cancer cell proliferation and migration using siRNA silencing. Results: Nurr1 expression in tumor cells correlated with increasing tumor stage and invasive growth pattern. Disease specific survival was significantly shorter in patients whose tumors showing a high level of cytoplasmic Nurr1 compared to those with lower levels of cytoplasminc Nurr1 expression. Furthermore, cytoplasmic Nurr1 expression level was an independent predictor of diesease specific survival (odds ratio 4.894 and p ⬍ 0.001). In vitro, silencing of endogenous Nurr1 attenuated the migration of bladder cancer cells. Conclusions: The expression of Nurr1 in the cytoplasm correlates with adverse outcome and is a independent prognostic marker for tumor progression and survival in patients with bladder cancer. This might represent a novel target in bladder cancer therapy.
UP-3.018 Telomerase Activity in Bilharzial Squamous Cell Carcinoma of the Bladder Hassouna M1, Ibtessam R2, Samia E2 1 Dept. of Urology, Faculty of Medicine, Alexandria University, Alexandria, Egypt; 2Medical Research Institute, Alexandria, Egypt Introduction and Objective: The clinicopathologic pattern of Bilharzial bladder cancer differs than that of T C C. Telomerase activity in such tumors was evaluated. Materials and Methods: Thirty patients with Sq c c and 30 controls were included in this study for RT-PCR of telomerase. Results: Telomerase sensitivity in Sq cell carcinoma was 94.7%. A low specificity rate of only 66% was detected. Conclusions: Telomerase activity shows a higher sensitivity in Bilharzial sq. c.c. than that of T.C.C. of the bladder. The sensitivity of that test is much lower than previously detected in the literature. The high false positive rates greatly limit the use of this test.
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UP-3.019 Bladder Tumors in Young People Minciu R, Boiborean P, Daminescu L Department of Urology, University of Medicine and Pharmacy “V.Babes”, Timisoara, Romania Introduction and Objective: Cancers are considered to be more aggressive in young people. We wanted to evaluate this statement in case of bladder cancer. Materials and Methods: In a period of four years, we diagnosed 39 new cases of bladder cancer in patients younger than 50 years. These patients were divided in two groups: Group A – patients younger than 40 years (7 cases) and group B- patients between 40 and 50 years (32 cases). Males were more frequent than females in both groups: M/F ⫽ 2.5 in group A and more evident in group B, M/F⫽7. Results: All tumors in group A were superficial non muscle invasive (Ta, T1). In group B most of the tumors were superficial (62.5%), but muscle invasive tumors were also diagnosed (37.5%). All tumors in group A were low graded, while in group B high grade tumors were also diagnosed (12.5%). None of the patients under 30 years encountered recurrence during follow up and only 2 patients between 30 and 40 years were operated again for same T and G recurrence. Conclusions: Bladder malignant tumors in young people (under 40 years) have a low agressivity: they are superficial and low grade tumors. Tumors in patients between 40 and 50 years have the same characteristics as in older people (over 50 years). UP-3.020 Recurrence Rates after Photodynamic Cystoscopic Resection of TCC Bladder Nair R, Shaw G, Schaerf D, Nitkunen T, Bunce C Barnet & Chase Farm Hospitals NHS Trust, London, United Kingdom Introduction and Objective: Photodiagnostic cystoscopy utilizes Hexa ALA instilled into the bladder pre-operatively to assist in the detection of transitional cell carcinomas and carcinoma in situ which might be missed on conventional white light cystoscopy. This chemical renders the abnormal mucosa red when visualized under blue light thereby making the lesions more easily detectable than under white light. TURBT performed using photodynamic therapy allows the surgeon to check the completeness of the resection and visualize flat/small tumours not easily seen under white light alone. Materials and Methods: The case notes
of 71 patients newly diagnosed with nonmuscle invasive TCC bladder without CIS diagnosed at TURBT were identified. 24 patients had TURBT with photodynamic assistance. 47 had standard white light TURBT. The recurrence rates were analysed at follow up cystoscopy. Results: The recurrence rates were 15% vs 45% in the photodynamic assisted TURBT group and the standard TURBT groups respectively (p⬍0.05, t-test). The mean time to follow up cystoscopy was 4 months. The range was 0.93-9.74 months. The photodynamic group was composed of 18% G1, 52% G2 and 30% G3. The staging for this group was 78% pTa, 22% pT1. The standard group was composed of 27% G1, 54% G2 and 19% G3. The staging for this group was 89% pTa, 11% pT1. Three G3pT1 tumours were resected using in each group. In the photodynamic group no recurrence/residual tumour was seen at re-resection after an average of 3.12 months. In the standard light TURBT group 2 patients had further tumour resected at the second look TURBT after an average of 3 months. Conclusion: The use of photodynamic cystoscopy to identify TCC in patients newly diagnosed with TCC bladder would seem to result in lower rates of recurrence. Correct assessment of tumour grade and stage is particularly important in patients with G3pT1 disease. Hexa-ALA instillation is helpful in assisting in complete resection of tumours. UP-3.022 Timing of Complications after Radical Cystectomy for Bladder Cancer Thorstenson A, Jonsson M, Henningsohn L, Hosseini A, Wikjstrom H, Schumacher M, Wiklund P Department of Urology, Karolinska University Hospital, Stockholm, Sweden Introduction and Objective: To present the survival and time of occurrence of complications in patients who have undergone radical cystectomy and urinary diversion due to bladder cancer. Materials and Methods: A total of 148 patients underwent radical cystectomy and urinary diversion due to bladder cancer at the Karolinska University Hospital during 2000-2005. Twenty-four male patients underwent prostatic capsule and seminal sparing cystectomy and seven patients underwent robot assisted laparoscopic cystectomy. Lymph node dissections were performed in 63% of the patients. Ileal conduits were performed in 47%, continent cutaneous reservoirs in 3% and orthotopic neobladders in 50% of the patients.
UROLOGY 74 (Supplment 4A), October 2009
UNMODERATED POSTER SESSIONS
UP-3.022, Table 1. Type, Frequency and Time of Occurrence of Complications in the 148 Patients Who Underwent Cystectomy and Urinary Diversion Complication Day 1-30 Complication Day 30-90 Complication Day > 90 Total No. of Patients Type of Complication (No. of Patients) (No. of Patients) (No. of Patients) with Complications Urosepsis (positive urinary culture) 16 4 12 32 Wound infection 22 1 2 25 Renal failure (S-creatinine ⬎200 mol/L) 3 1 12 16 Sepsis (negative urinary culture) 12 3 0 15 Cutaneous fistula from bowel 7 2 2 11 Wound hernia 0 0 11 11 Parastomal hernia 0 0 10 10 Abscess 5 1 2 8 Strictured anastomosis between Wallace 0 0 7 7 plate and urinary diversion Intestinal perforation 5 0 1 6 Strictured anastomosis orthotopic 0 0 5 5 substitution-urethra Insufficient anastomosis between Wallace 4 0 0 4 plate and urinary diversion Stone in the urinary diversion 0 0 4 4 Non functioning uretery catheters and 3 0 0 3 subsequent nephrostomy tube Ureteric stone 0 1 0 1 Stenosis of cutaneous stoma 0 0 1 1 Total No. of patients with complications 77 13 69 159
Results: The 148 patients had an overall survival rate of 55% and a cancer-specific survival of 62% at five years. Three patients (2.1%) died in the early postoperative period (myocardial infarction, insufficient bowel anastomosis and aspiration pneumonia). We observed 159 complications. The type, frequency and time of occurrence of the complications are presented in the Table. Urosepsis was the most frequent complication and occurred in 32/148 patients (22%). The complications occurred more than 90 days after the operation in 69/159 patients (43%). Complications that commonly occurred more than 90 days after the radical cystectomy were: renal failure, hernia, strictures and stone in the urinary diversion. Conclusions: Patients who undergo radical cystectomy frequently suffer from various complications. Our data show that 43% of the complications occur more than 90 days after the operation, why long term data is necessary when discussing complications in this group of patients. UP-3.023 Five-Year Result of Cutaneous Catheterizable Continent Diversion with Extramural Supported Tapered Ileum Efferent Tube Zhang X, Xu X, Qiao Y, Wu D, Sa Y, Zhang J, Chen R Shanghai Jiaotong University Afilliated Shanghai 6th People’s Hospital, Shanghai, China
Introduction and Objective: To evaluate long-term clinical outcomes in patients who received cutaneous continent diversion (CCD) with extramural supported tapered ileum outlet. Materials and Methods: Eighty-four consecutive patients (63 male and 21 female, 6-78 year-old) received a CCD with extramural supported tapered ileum outlet operation in our hospital from October 1999 to July 2003. Two extramural supporting ways to enhance the tapered ileum outlet continent mechanism were used: 1. The tapered ileum was fixed to the back surface of the rectus muscle by using two 1-cm wide polyester tapers with a suspension tension of 500 gram in 39 patients. 2. An additional 5-cm ileal segment was placed between the back surface of the rectus muscle and the W-shaped ileal pouch wall in another 45 patients. The early and long term complications, re-operation rate and continent rate were followed. Results: One patient died due to heart disease 55 days after operation; 8 patients (9.6%) had early complications within 60 days postoperatively in which 2 (2.4%) patients received re-operation. Twentytwo patients (26.5%) had 23 long-term complications, of which 5 were related to outlet (2 in polyester tapers and 3 in additional ileal segment) and 5 patients (6.02%) received re-operation. Among 52 patients who were followed-up recently (61-91 months, average 66.3⫾4.03 months), 4 patients were not able to live
UROLOGY 74 (Supplment 4A), October 2009
a self-care life, 5 patients required detained duct, of which the reasons were varied from continent mechanism failure in 2 (each extramural supporting way had one), gradually serious celiodynia after reservoir volume exceed 100 ml in 1, refusing another operation to reshape the unilateral urethra reflux in 2. Other 48 patients could empty the reservoir by cleaning intermittent self-catheterization, continence was achieved in 43 patients (89.6%) and 37 were completely continent day and night (77.1%). Satisfied continence rate was achieved in 77.3% (17/ 22) and 76.9 % (20/26) of patients applying polyester tapers and additional ileal segment, respectively. Conclusions: Our data suggest that a stable, continuous and reliable continent ability could be obtained by tapered ileum outlet with extramural supported. Most of the complications of this procedure are mild and the re-operation rate is relatively low. UP-3.024 Outcome of Function with Studer Ileal Neobladder Replacement in Patients with Muscle Invasive Bladder Tumor (10 Years of Experience with 32 Cases) Mahdavi Zafarghandi R1, Arab D2, Shakibi M1, Mahdavi Zafarghandi M1 1 Department of Urology, Imam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, Iran; 2Mashhad University of Medical Sciences, Mashhad, Iran
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