World Chinese Urological Society Meeting.doc
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Welcome to WCUS meeting 2007 Dear Colleagues and Friends: On behalf of the scientific committee, it is our great pleasure to invite you to attend the 2 nd AUA World Chinese Urological Society (WCUS) meeting which will be held at the Hilton Anaheim hotel in Anaheim, California on May 19, 2007. The 1 st AUA WCUS meeting held in Atlanta, Georgia in 2006 was a great success with more than 300 Chinese-speaking urologists and urologic scientists attending the meeting. The 2007 meeting in Anaheim promises to be an even more exciting event. The meeting will begin with a series of lectures by the presidents of the urological associations of China, Taiwan, Singapore, Hong Kong and Macao on the “Highlights of Chinese Urology.” Following these lectures, experts in various fields – including benign prostatic enlargement, bladder cancer, endourology, pediatric urology, Nanomedicine and urinary stones – will lecture on “Practical Approaches to Patient Management.” In light of the tremendous advancements in basic and clinical research from the countries and regions mentioned above, we have also invited many accomplished urologists and scientists to present their findings and discoveries. In addition, the conference will feature a poster session that will provide yet another venue for discussion with the experts. The purpose of the AUA WCUS meeting is to facilitate exchange of ideas and experiences and foster communication and collaboration among Chinese-speaking urologists and urological scientists. Our goal is to attract the best and brightest Chinese scholars to attend and present at the annual AUA meetings. Although the presentations will be in Mandarin, the slides and posters will be in English. We welcome anyone with an interest in Chinese urology to attend the meeting. Tom F. Lue, MD, FACS Chairman, Scientific Committee Run Wang, MD, FACS
description
Transcript of World Chinese Urological Society Meeting.doc
Welcome to WCUS meeting 2007
Dear Colleagues and Friends:
On behalf of the scientific committee, it is our great pleasure to invite you to attend the 2 nd AUA World
Chinese Urological Society (WCUS) meeting which will be held at the Hilton Anaheim hotel in
Anaheim, California on May 19, 2007.
The 1st AUA WCUS meeting held in Atlanta, Georgia in 2006 was a great success with more than 300
Chinese-speaking urologists and urologic scientists attending the meeting. The 2007 meeting in
Anaheim promises to be an even more exciting event. The meeting will begin with a series of lectures
by the presidents of the urological associations of China, Taiwan, Singapore, Hong Kong and Macao on
the “Highlights of Chinese Urology.” Following these lectures, experts in various fields – including
benign prostatic enlargement, bladder cancer, endourology, pediatric urology, Nanomedicine and urinary
stones – will lecture on “Practical Approaches to Patient Management.” In light of the tremendous
advancements in basic and clinical research from the countries and regions mentioned above, we have
also invited many accomplished urologists and scientists to present their findings and discoveries. In
addition, the conference will feature a poster session that will provide yet another venue for discussion
with the experts.
The purpose of the AUA WCUS meeting is to facilitate exchange of ideas and experiences and foster
communication and collaboration among Chinese-speaking urologists and urological scientists. Our
goal is to attract the best and brightest Chinese scholars to attend and present at the annual AUA
meetings. Although the presentations will be in Mandarin, the slides and posters will be in English. We
welcome anyone with an interest in Chinese urology to attend the meeting.
Tom F. Lue, MD, FACS
Chairman, Scientific Committee
Run Wang, MD, FACS
Executive Chairman, Scientific Committee
Guiting Lin, MD, PhD
Secretary
Scientific CommitteeTom F. Lue, MD, FACS-Chair (USA)
Department of Urology
University of California at San Francisco
USA
Run Wang, MD, FACS-Executive Chair (USA)
Department of Urology
University of Texas Medical School at Houston
University of Texas MD Anderson Cancer
Center
USA
Yinghao Sun, MD, PhD (Shanghai)
Department of Urology
The 2nd Military Medical University
Shanghai
China
Hong Li, MD (Chengdu)
Department of Urology
Sichuan University
Chengdu
China
Ningchen Li, MD (Beijing)
Beijing Urology Institute
Beijing University
Beijing
China
Liqun Zhou, MD (Beijing)
Beijing Urology Institute
Beijing University
Beijing
China
Yutian Dai, MD, PhD (Nanjing)
Department of Urology
Nanjing University Medical College
Nanjing
China
Joseph Chin, MD (Canada)
Department of Urology
University of West Ontario
London
Canada
Eugen Yuhui Wang, MD, PhD (Sweden and
Norway)
Department of Urology
Aker University
Oslo
Norway
Shu Tung, MD (USA)
Division of Urology
University of Texas Medical School at Houston
USA
Philip Li, MD (USA)
Department of Urology
Cornell University Medical School
New York
USA
Jun Chen, MD (Taiwan)
In-Hei Lee, MD (Taiwan)
Ian Lap Hong, MD, PhD (Macau)
Department of Urology
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CHCSJ Hospital
Macau
China
Tak-Hing Bill Wong, MD, FRCS (Hong Kong)
Department of Urology
Chinese University of Hong Kong
Hong Kong
China
Apichat Kongkanand, MD (Thailand)
Bangkok
Thailand
Hui Ming Tan, MD (Malaysia)
Kuala Lumpur
Malaysia
Keong Foo, MD (Singapore)
Leland Chung, PhD (USA)
Emory University
Atlanta
USA
K K Chew, MD, PhD (Australia)
Perth
Australia
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World Chinese Urological Society Meeting
Theme: State-of-World Chinese Urology
Saturday, May 19, 2007
The Anaheim Hilton & Towers, Anaheim, California, USA
8:00 am - 8:07 am Welcome and introductionTom F. Lue, USA
8:07am – 8:10am Report from Scientific Program Committee Run Wang, USA
8:10 am – 9:10 am Session I: Highlight on Chinese Urology Moderators: Chung Lee, USA; Luke S. Chang, Taiwan; Tak-Hing Bill Wong,
Hong Kong
8:10-8:20am Yanqun Na, President, Chinese Urological Assoc.8:20-8:30am Han-Sun Chiang, President, Taiwan Urological Assoc.8:30-8:40am Christopher Cheng, President, Singapore Urological Assoc.8:40-8:50am Wai Sang Wong, President, Hong Kong Urological Assoc.8:50-9:00am Son Fat Ho, President, Macao Urological Assoc.
9:00-9:10am WCUS awards
9:10 am -10:30 am
Session 2: Scientific Program: Practical approach to patient managementModerators: Yanqun Na, China; Leland Chung, USA; Apichat Kongkanand, Thailand
9:10-9:30am Revisit balloon dilation for BPH: 10-year experience Yinglu Guo, Liqun Zhou, China
9:30-9:50am How do I manage patient with bladder cancer? Joseph Chin, Canada
9:50-10:10am Minimally Invasive Surgery for Vesicoureteric Reflux Chung Kwong Yeung, Hong Kong
10:10-10:30am Tricks on Management of Urinary Stone Disease Marshall Stoller, USA
10:30 am -10:45 am Tea and Coffee Break
10:45 am -12:00 noonSession 3: Scientific Program: Basic science forumModerators: Dalin He, China; Philip Li, USA; Hui Meng Tan, Malaysia
10:45-11:00am Nanotechnology, Nanomedicine, and Nanosurgery: An Urologist’s Perspective
Joseph C. Liao, USA
11:00-11:15am Intravesical and intraprostatic botulinum toxin administration in rat models of interstitial cystitis and non-bacteria prostatitisYao-Chi Chuang, Naoki Yoshimura, Chao-Cheng Huang, Po-Hui Chiang, Pradeep Tyagi, and Michael B. Chancellor, Taiwan and USA
11:15-11:30am Effect of changes of detrusor-original excitability on the overactive detrusor Bo Song, China
11:30-11:45am Bladder primary sensory neuron block: animal and clinical application Zhichen Guan, China
11:45-12:00am Discussion
12 Noon-1 pm: Box Lunch and Viewing of Posters and Videos
1:00 pm - 2:00 pm
Session 4: Scientific program: Discussion of posters and videosModerators: Shujie Xia, China; Eugen Y. Wang, Sweden; Jun Chen, Taiwan
Upper urinary tract
1:00-1:03pm Pyeloplasty: retroperitoneal laparoscopic vs. open approaches Xu Zhang, China
1:03-1:06pm Graft Outcome of Living Donor Renal Transplantation in the Elderly Recipients Feng-Pin Chuang, Andrew C Novick, Guang-Huan Sun, Michael Kleeman,
Stuart Flechner, V. Krishnamurthi,Charles Modlin, Daniel Shoskes, David A.Goldfarb, Taiwan and USA
1:06-1:09pm Laparoscopic repair of injury to the inferior vena cava-report of three cases (Video) Liqun Zhou, China
1:09-1:12pm Retroperitoneal laparoscopic Radical Nephrectomy and regional lymphadenectomy for Renal Cell Carcinomas Wei Zhang, China
1:12-1:15pm Correlation of COX-2 Expression in Stromal Cells with High Stage, High Grade and Poor Prognosis in Urothelial Carcinoma of Upper Urinary Tracts Chih-Hsiung Kang, Po-Hui Chiang, Shun-Chen Huang, and Hsuang-Lan Yu, Taiwan
1:15-1:18pm Endoluminal ureteroplasty for ureteroenteric stricture – a feasibility study in porcine model. Victor Chia-Hsiang Lin, Allen W. Chiu, Mihir M. Desai, Inderbir S. Gill,Taiwan and USA
1:18-1:21pm Laparoscopic radical nephroureterectomy with concomitant radical cystectomy for multi-focal transitional cell carcinoma in uremic patients: initial experience Victor C. Lin, Allen W. Chiu, Y. H. Lee, T. J. Yu, Taiwan
Prostatic diseases
1:21-1:24pm Prostate cancer management consensus and guidelines between china and taiwan Chih-cheng Lu, Chia-Ho Lin, Dennis Chian-Shiung Lin, Eric W. Fan, Tse-Chou Cheng, Taiwan
1:24-1:27pm The guidelines or consensus in managing benign prostatic hyperplasia among china, singapore and taiwan Chih-cheng Lu, Chia-Ho Lin, Dennis Chian-Shiung Lin, Eric W. Fan, Tse-Chou Cheng, Taiwan
1:27-1:30 Hemospermia associated with prostatic cyst: diagnosis by transrectal ultrasonographic finding and endorectal coil MR imaging. Twenty four case reportsWei-Dong Song, Liang Chen, Zhong-Cheng Xin, Long Tian, Bao-Xing Liu, Xiao-Jun Wu,China
Andrology
1:30-1:33pm China experience of penile prosthesis implantation for sever erectile dysfunctionZhong Cheng Xin, Zhi Chao Zhang, Wei Dong Song, Long Tian, china
1:33-1:36pm Sural Nerve Grafting During Laparoscopic Radical Prostatectomy---Initial
experiences of two patients Xin Gao, China
1:36-1:39pm Erectile Dysfunction Following Transurethral Electrovapor Resection for Different Sized ProstatesChih-Kuang Liu, Ming-Chung Ko, Huey-Sheng Jeng, Wen-Kai Lee, Hong-Jeng Yu, Han-SunChiang, Taiwan
1:39-1:42pm A mode of treatment for penilie incarceration ----an unusual complication of masturbationJesun Lin, Gin-Bow Chang, Herng-Jye Jiang, Mon-I Yang, Huai-Long Tai, and Bai-Fu Wang, Taiwan
1:42-1:45pm Effect of Cox7a2 on LH induced testosterone production and expression of StAR protein, P450scc and 3β-HSD enzymes in TM3 mouse Leydig cellsLiang Chen,Zhong-Cheng Xin , Long Tian, Yi-Ming Yuan, Gang Liu , Ying-Lu Guo, China
1:45-1:48pm Association of the phenotype of seminal vesicles and cftr gene mutation in patients with congenital bilateral absence of the vas deferensChien-Chih Wu, Chia-Hung Liu, Han-Sun Chiang, Taiwan
Urinary bladder
1:48-1:51pm Proteomic analysis of human urinary cancer proteome using reverse phase nano-high-performance liquid chromatography / electrospary ionization tandem mass spectrometry.
Tan Lia-Beng, Liao Pao-Chi, and Guo Haw-Ran, Taiwan.
1:51-1:54pm Survival Analysis of Patients with Bladder Transitional Cell Carcinoma after Open or Laparoscopic Radical CystectomyAllen W. Chiu, Thomas Y. Hsueh, Steven K. Huan, Yi-Hsiu Huang, Taiwan
Stem cells
1:54-1:57pm Characterization and Differentiation of Human Muscle Derived Stem Cells. Shing-Hwa Lu, An-Hang Yang, Chou-Fu Wei, Kuang-Kuo Chen,Luke S. Chang, Taiwan
1:57-2:00pm Brief Break
2:00 pm - 2:40 pm
Session 5: CUA LecturesModerators: Liqun Zhou, China; Shu Tung, USA; Shaw W. Zhou, USA
2:00-2:20pm Endourology in China: Current status and future direction Yinghao Sun, China
2:20-2:35pm Evidence-based Urology: report from China Qiang Wei, China
2:35-2:40pm Discussion
2:40 pm - 2:50 pm Tea and Coffee Break
2:50 pm – 3:50 pm.
Session 6: Scientific Program: Clinical ResearchModerators: Hong Li, China; Po-Hui Chiang, Taiwan; Ningchen Li, China
2:50-3:05pm The Incidence and Clinical Significance of High-Grade Prostatic Intraepithelial Neoplasia on Prostate Biopsy in Taiwanese Asian Men Yen-Hwa Chang, Yi-Chun Chiu, Chin-Chen Pan, Kuang-Kuo Chen and Luke S. Chang,
Taiwan
3:05-3:15pm Prostate cancer in Macau S.A.R Lap hong Ian, Macau
3:15-3:30pm Efficacy and Safety of Tolterodine and/or Tamsulosin in Men with Lower Urinary Tract Symptoms (LUTS) Including Overactive Bladder (OAB): Results from a Four-Arm, Placebo-Controlled Trial Zhonghong (Eric) Guan, USA
3:30-3:40pm Laparoscopic Radical Cystectomy with Orthotopic Ileal Neobladder: A Report of 85 Cases
Jian Huang, China
3:40-3:50pm Discussion
3:50 pm - 4:00 pm
Closing remark
Yanqun Na, China & Luke S. Chang, Taiwan
ABSTRACTS
1. Revisit balloon dilation for BPH: 10-year experience
-----The Treatment of BPH by Muti-Balloon Dilation
(MBD)
Yinglu Guo M.D
Department of Urology, First Hospital of Peking University, Urologist
Training College of Peking University. Beijing, 100034,P.R China
While China has stepped into the aged society, there are
more then several ten millions people are suffering from
the BPH. An effective and economic therapy method is
eagerly required for those people of BPH because there is
no good method to prevent and to eliminate it totally in
China nowadays. Also, lots of other factors have blocked
the process to reach this aim in China, such as
equipments, skilled urologist, and the economic condition
of those patients in the rural areas.
The single balloon dilation, a method for treating BPH
that had been applied in the clinic in the middle of 80s’,
was an effective approaches to treat those patients with
minimum symptoms, although it has been abounded for
bleeding after the dilation and the long-term effects. Ten
years later, this technique has been improved into another
effective method, the muti-ballon dilation (MBD), which
was applied in the clinic successfully with an excellent
outcome.
There are several key techniques were developed for the
muti-balloon dilation. To stop the bleeding after dilation,
the period of dilation has been prolonged to 24 hr, which
resulted the necroses and apoptosis of glands and
sympathetic nerve ending in the prostate. To increase the
effectiveness of dilation, several other tissues have been
recruited in, such as bladder neck and urethral sphincters.
It is need to be noticed that the balloon on the site of
urethral sphincters was released immediately after dilation
in case of the incontinence.
The muti-balloon dilation has been applied to treat those
BPH patients with residual urine. Five days later after the
dilation, all the patients regained the urination although
some of them with temporary stress incontinence. The
urination was successfully improved during the post
dilation period. The maximum urinate rates were reached
to 11ml/s in all those patients and some of them reached
to 20ml/s even after 12 years of dilation.
To explore the mechanism of this new method, the
animal experiments and more clinic trails will be
applied. Also, the catheter and the balloon will be
improved for the best outcome.
2. How do I manage patient with bladder cancer?
Joseph Chin, MD
Professor of Surgery, UWO, Head, Surgical Oncology, London
Health Sciences Centre
Victoria Hospital, Canada
The goals of therapy for non-invasive transitional cell
bladder cancer are (1) Prevent recurrence and
progression, (2) Minimize morbidity and expense e.g.
with cystectomy and (3) Identify
refractory/progressive disease before it becomes
metastatic. One should remember that only 2% of
TaG1-2 cancers progress. However, 50% of Tis
progress and that 25% of T1G3 die of TCC without
extirpative therapy. Sixty percent of such patients are
60% cured with radical cystectomy if they have timely
aggressive intervention. Approximately 50% of those
who pursue bladder–sparing therapy can be cured with
radical radiotherapy with or without systemic
chemotherapy, but 40% require salvage cystectomy
Low-Risk Non-Invasive Cancers
Approximately 60% of newly diagnosed cases are
low-risk (Grade 1 - 2, Stage Ta, T1). Transurethral
resection (TUR) should include biopsy of tumor base.
Since approximately 50% will recur and 15 - 25%
recur with higher grade disease, the key question is
whether and when to institute intravesical therapy.
My criteria for intravesical therapy after initial TUR in
non-invasive disease include :
1. Presence of CIS, 2. T1 disease, 3. Presence
of multiple tumors, 4. large initial tumor (>3
cm.diameter), 5. Grade 3 disease.
A second TUR is performed within 6 weeks if the
initial TUR failed to include muscularis propria in the
specimen or if there is doubt about the completeness
of the initial resection.
Fluorescence-Assisted TUR may be useful in cases of
suspected carcinoma in situ, to detect “occult”.
In case of early recurrences (within 2 -3 moths),
intravesical therapy with BCG would be instituted
promptly. Another indication for intravesical therapy is
presence of unresectable superficial TCC due to difficult
anatomy and location.
High Risk Non-Invasive Cancers
Since 80% of T1 Grade 3 disease, with or without
concomitant CIS, will recur and since up to 45% of these
may develop invasion and eventually become metastatic,
T1G3 disease has to be regarded as high-risk and treated
aggressively. Intravesical therapy is used early in the
disease course. The threshold for radical cystectomy
should be low, if there is any early sign of failure of
conservative therapy.
Intravesical Therapy
BCG is usually used as first-line with a 6 week-course.
Maintenance regimen is routinely used monthly for 3
months. Occasionally, more intensive and longer
maintenance regimens (e.g. as per Dr. Lamm) are used.
Second-line therapy commonly sued are Mitomycin and
low-dose BCG plus interferon.
Invasive Disease and Failed Treatment in Non-Invasive
Disease
Radical Cystectomy is usually undertaken in these
circumstances, provided the patient’s operative risks are
reasonable. A bladder-sparing approach, with a
combination of external beam radiotherapy and systemic
chemotherapy may be used, especially if the patient has
high risks with medical co morbidities.
The choice of urinary diversion depends on (1) patient
age, (2) co-morbidities, (3) tumor stage/type/location, (4)
patient preference. My personal break-down is
approximately 65%/35% ileal conduit/Studer ileal
neobladder.
Advanced Disease
Neoadjuvant chemotherapy (most commonly cis platinum
and Gemcitabine combination) is used occasionally to
downsize locally advanced bulky cancers in patients
being considered for aggressive surgical therapy. The
alternative is to proceed with cystectomy first and then
institute adjuvant chemotherapy in those deemed to likely
benefit from adjunctive systemic therapy.
3. Minimally Invasive Surgery for Vesicoureteric
Reflux
C.K.YEUNG, MD, FRCS, FRACS, FACS
Chair Professor of Paediatric Surgery of Pediatric Urology,
Director, Minimally Invasive Surgery Centre
Chinese University of Hong Kong, Hong Kong
Over the past few years, there have been remarkable
improvements in both skills and technology in
Minimally Invasive Surgery (MIS) in children. We
are now having much better optics and finer
instruments, specially tailored for work in small
infants, and along with improved surgical as well as
anaesthetic techniques, we have seen explosive
expansion both in the scope and complexity of the
work that one can do. In addition, the advent of the
computer-assisted or robotic technology over the past
3-4 years, has given further major impetus for new
developments of MIS in all aspects of operative
paediatric urology.
Various minimally invasive surgical techniques are
now available for the management of vesicoureteral
reflux (VUR). These include cystoscopic subureteric
injection of various types of bulking agents,
endoscopic ureteral advancement and trigonoplasty,
and endoscopic ureteric reimplantation through a
transperitoneal extravesical approach. With the advent
of laparoscopic surgery, extravesical laparoscopic
ureteral reimplantation for VUR utilizing the Lich-
Gregoir technique has been reported in children.
However, this approach necessitates transgression of
the peritoneal cavity and can be technically difficult in
the small pelvis of a young infant. In addition, a
significant proportion of children with bilateral reflux
undergoing bilateral extravesical ureteral
reimplantation developed voiding dysfunction and
urinary retention post-operatively. From a pilot
animal model using piglets we have found that under
carbon dioxide insufflation of the bladder at around 10
mm Hg pressure, a large potential working space
could be obtained that would allow various
intravesical procedures, including a Cohen’s type of
cross-trigonal ureteral reimplantation, to be easily
conducted endoscopically using standard laparoscopic
instruments.
The endoscopic procedure was preceded by distension of
the bladder with saline and insertion of a 3-5 mm Step
port over the bladder dome under cystoscopic guidance.
The bladder was then drained and insufflated with carbon
dioxide to 10-12 mm Hg pressure, with a suction catheter
inserted per urethra to occlude the internal urethral
meatus. A 5 mm 30 degree scope was used to provide
intravesical vision. Two more 3-5 mm working ports were
then inserted on the lateral bladder wall on either side.
Endoscopic intravesical mobilization of the ureter,
dissection of a submucosal tunnel and a Cohen’s type of
cross-trigonal ureteric reimplantation using interrupted 5-
zero monofilament sutures was then performed under
videoscopic guidance. Bladder drainage with urethral
catheter was maintained for 24 hours post-operatively.
Using this technique, we have successfully performed
ureteric reimplantation in over 180 patients with gross
VUR since 1999. Our experience illustrates that
endoscopic intravesical ureteric mobilization and cross-
trigonal ureteric reimplantation can be very safely and
effectively performed with routine laparoscopic surgical
techniques and instruments under carbon dioxide
insufflation of the bladder, achieving a very high success
rate in reflux resolution that is at least equivalent if not
better than the open technique, but with much less post-
operative pain and bladder spasm, and much faster
recovery.
With this early experience, we have established a
combined MIS treatment protocol for VUR, with a
selective use of dextranomer/hyaluronic acid copolymer
(Deflux) subureteic injection for mild grades or
uncomplicated VUR and pneumovesicoscopic ureteric
implantation for severe grades or complicated VUR
Since 2001, children presenting with primary
vesicoureteral reflux (Grade 1 to Grade V) were
prospectively recruited. At entry, each patient had a
voiding cystourethrogram (VCUG), renal ultrasonogram
(US), isotopic renogram (DMSA).The minimally invasive
management protocol included 1) pneumovesical ureteric
reimplantation and 2) endoscopic sub-ureteric injection.
Children with severe dilating primary vesicoureteral
reflux, (Grade IV bilateral to Grade V) associated with
recurrent urinary tract infections and multiple
pyelonephritic renal scarring underwent endoscopic
Cohen’s cross-trigonal ureteral reimplantation with
carbon dioxide pneumovesicum. Endoscopic sub-urete
ric injection was given to the children with milder gra
de (Grade II to Grade III and Grade IV Unilateral
Resolution of VUR at a minimum follow up period of
6 months after the procedure was then evaluated.
Using this combined MIS treatment protocol, 117
children were prospectively treated and followed up.
Endoscopic cross-trigonal ureteric reimplantation was
successfully performed in ninety three children (M/F:
72/21, Mean age: 5.1 + 5.61) with dilating primary
vesicoureteral reflux (42 bilateral; 135 refluxing
ureters) and endoscopic sub-ureteric injection has
given to 24 children (M/F: 8/16, Mean age: 5.75 +
3.61yrs) with milder grade VUR (- bilateral; -
refluxing ureters). Follow-up cystogram showed
complete resolution of VUR in 91 of 93 patients
(97.8%) and in 22 of 24 patients (92%) undergoing
ureteric reimplantion and subureteric Deflux injection
respectively. VUR was downgraded in the remaining 2
patients who underwent ureteric reimplantation. VUR
grade remained unchanged in 2 patients (8.3%) treated
with subureteric injection and they were treated
successfully by repeat injection.
In summary, our new treatment algorithm with
minimally invasive treatment offers effective cure for
children with all grades of VUR. The treatment aims
at an early cure and higher success rate by eliminating
the risk of progressive renal damage. Moreover, this
treatment is easily acceptable by patients and parents
as there is much less trauma to the child, and its high
cure rate alleviating the need for long-term follow-up
of the patient with radiological investigations and
antibiotic treatment
4. Tricks on Management of Urinary Stone Disease
Marshall Stoller,
Department of Urology, University of California at San Francisco.
USA
Percutaneous nephrolithotomy (PNL)
Positioning and Set up:
1. Flexible cystoscopy on gurney
2. Placement of localizing ureteral catheter
3. Connect ureteral catheter to extension tubing (12-14
inches), then a syringe of contrast (flush tubing,
careful not to get contrast into catheter)
4. Secure to Foley
5. Flip patient prone onto bolsters (made of rolled up
blankets, gel rolls can compromise X-ray/images)
6. Shoulders and elbows flexed less then 90 degrees
7. Pad all pressure points and secure patient to table
8. Ensure easy access to syringe for retrograde contrast
injection
Imaging:
1. Lower room lights and bring patient as close to C-
arm sensor (beam should come from under the table
to reduce radiation exposure)
2. Take scout film
3. Under active fluoroscopy, inject contrast via
localizing catheter at a slow rate
4. Understand stone and renal collecting system
anatomy
5. Lower pole inferior calyx is typically no the most
inferior
Access:
1. Goal is to access the posterior calyx at its tip to
minimize the distance of renal tissue traversed (this
will minimize bleeding)
2. The access tract should be straight onto the stone
3. 18ga needle with removable cutting inner
obturator/stylet
Anatomy & Puncture Site:
1. Identify the 11th and 12th rib
2. Identify the paraspinous muscles
3. Start with X-ray in AP view
4. For lower pole punctures,
a. Enter skin 2cm later to the lateral edge of the
paraspinous muscles and 2cm inferior to the rib
(Petit’s Triangle)
b. Enter at 30 degrees from the skin surface and
aim towards contralateral nipple
c. rotate C-arm sensor towards you to assess depth
of puncture
d. If the needle is under the stone your needle is too
superficial
5. For upper pole punctures,
a. Select either medial or lateral calyx
b. Enter directly over stone (“bull’s eye”)
c. Use packing forceps to direct needle and
reduce radiation exposure
d. Rotate C-arm sensor away from you to assess
puncture depth
6. Aberrant anatomy may require ultrasound
guidance or CT imaging
Tract Dilation:
1. Once in collecting system, pass J-tip, flexible
wire into collecting system
a. Do not spend much time trying to get guidewire
down ureter and into bladder
2. If wire does not pass easily, you may be in an
anterior calyx
3. In general, only dilate into a posterior calyx
4. Dilate tract via 8F fascial dilators (can increase
stiffness by soaking in ice-slush)
5. “Push/Pull” technique. As you advance the dilator,
actively push and pull wire 1-2mm to keep wire
straight (this avoids kinking of the working wire)
6. Repeat process for the 8/10F safety wire introducer
7. Place a second, safety, wire when possible
8. If significant bleeding is encountered during
dilation, place nephrostomy tube and clamp it to
tamponade bleeding, reassess after 5 minutes
Balloon system-
Tip of radiomarker advanced just into tip of calyx
Dilate to 24 or 30F under fluoroscopy
Advance sheath to the “waist” of the balloon
Careful not to over advance sheath onto the “cone”
portion of the balloon
Alken-
Ensure tight and snug fit of all dilators in set Do not
skip a dilator size
Control tip of dilator at all times
Amplatz
Dotter catheter must be placed over wire first
Dotter tip just into collecting system
Sequential dilation must not go too medial
Working sheath to the “waist” of the dilator
Careful not to over advance sheath onto the “cone”
portion of the dilator
Initial Entry:
1. Rigid nephroscope must have
adjustable suction (e.g., ultrasound lithotrite) when first
entering collecting system2. Look up at 12 o’clock if can
not find your way in
Operative hints:
1. Suction management
2. Irrigation management (both from nephroscope and
from retrograde ureteral catheter
3. Use a broad front for larger stones
4. Use room temperature saline for irrigation (set at 30-40
cm above kidney) to help reduce fogging of
camera/lens
Physiology, minimizing bleeding
1. Avoid hypothermia, use active warming blanket system
2. Mannitol 12.5 g IV can decrease venous bleeding by
swelling kidney
3. Avoid excessive torque and force on kidney (safer to
use second puncture or flexible nephroscope)
Nephrostomy Tube Placement
1. Direct a stiff wire or a 5F ureteral
catheter into desired location
2. Cut off the tip of any Foley catheter
1mm distal to the balloon
3. “Push/Pull” the Foley catheter into
desire location (confirm with contrast in the balloon,
then with a nephrostogram)
4. In obese patients with thick
subcutaneous tissue, place nephrostomy tube as far in
as possible (e.g., in an upper-pole calyx for a lower
pole puncture; or in a lower-pole calyx for an upper-
pole puncture)
5. In obese patients, a nephroureteral
catheter also can be used
5. Nanotechnology, Nanomedicine, and Nanosurgery:
An Urologist’s Perspective
Joseph C. Liao, M.D.
Department of Urology S-287, Stanford University School of Medicine,
300 Pasteur Dr. Stanford, CA 94305-5118,USA
Nanotechnology is the understanding and manipulations
of natural and manmade materials at dimensions of 1 to
100 nanometers. This is the length scale of biological
molecules (e.g. DNA and proteins), where manmade
materials exhibit unique properties that enable novel
applications. Nanomedicine is the highly specific
medical intervention at the molecular scale for curing
disease or repairing damaged tissues. Nanomedicine
holds the promise of revolutionizing medical
diagnostics with ultrasensitive nanosensors for
detection of biological molecules, imaging with
nanoparticles for in vivo, real time visualization of
disease processes, and therapeutics through highly
precise targeted drug delivery systems. While
fundamental understanding of nanoscale research may
not be essential for the urologists, it is important to
grasp basic concepts of nanotechnology as it will
undoubtedly impact the clinical practice in the near
future. Proof of concept clinical application of
nanotechnology and its microscale counterpart—
microelectromechanical system (MEMS)—have
already been demonstrated in urology. This includes
detection of urinary pathogens and cancer biomarkers
using highly sensitive micro/nanosensor arrays. Use
of lymphotropic magnetic nanoparticles in conjunction
with MRI have been demonstrated to improve
detection of numerous urological cancers, including
prostate, bladder, and penile. Therapeutic applications
of nanoparticles have also begun to emerge in pre-
clinical settings for highly specific, targeted delivery
of chemotherapeutic agents for prostate cancer.
Currently, nanomedicine is still at its infancy and
nanosurgery, as the ultimate minimally invasive
surgery, has yet to be realized. Nanomedicine is a
highly translational research area that requires inter-
disciplinary collaboration from engineering, basic
science and clinical medicine. Institutional
commitment towards development of centers of
excellence that promote interdisciplinary collaboration
is not only preferred, but necessary. Participation of
the urologist in the team is essential given the
potential for exciting novel diagnostic and therapeutic
modalities for urological diseases.
6. Intravesical and Intraprostatic Botulinum Toxin A
Administration in Rat models of Interstitial
Cystitis and Non-bacteria Prostatitis
Yao-Chi Chuang 1, Naoki Yoshimura 2, Chao-Cheng Huang 3, Po-Hui
Chiang 1, Pradeep Tyagi 2, and Michael B. Chancellor 2
Department of Urology 1, Pathology 3, Chang Gung Memorial Hospital,
Kaohsiung Medical Center, Chang Gung University College of
Medicine, Kaohsiung, Taiwan and Department of Urology, University of
Pittsburgh School of Medicine 2, Pittsburgh, Pennsylvania
Introduction and Objectives: There is increasing
evidence that botulinum toxin A (BoNT-A) might have
analgesic properties but the mechanisms by which BoNT-
A alter pain remains largely unexplored. In the bladder,
afferent nerve fibers contain calcitonin gene-related
peptide (CGRP), which modulates sensory transmission
from the bladder. In this study we first investigated the
effect of intravesical BoNT-A administration on CGRP
immunoreactivity and bladder hyperactivity in acetic acid
-induced bladder pain model in rats. Second, an animal
model for non-bacterial prostatitis in rats was developed
using intraprostatic injection of capsaicin, an agent
thought to excite C-afferent fibers and cause neurogenic
inflammation. The analgesic and anti-inflammatory
properties of BoNT-A was tested in this model.
Materials and Methods: For bladder experiments,
experimental and control animals were catheterized and
intravesically exposed to protamine sulfate (PS, 1 ml, 10
mg/ml) followed by BoNT-A (1 ml, 25 unit/ml, Allergan,
Irvine, CA) or saline respectively. Three or seven days
after intravesical therapy, continuous cystometrograms
(CMGs) were performed under urethane anesthesia by
filling the bladder (0.08 ml/min) with saline, followed by
0.3% acetic acid. Bladder immunohistochemistry was
used to detect CGRP. For prostate experiments, adult
male S.D. rats were injected with varying doses of
capsaicin into the prostate. The nociceptive effects of
capsaicin were evaluated for 30 min by using a behavior
approach and then the prostate was removed for histology
and cyclo-oxygenase (COX)-2 protein concentration
measurement. Evans blue (50mg/kg) was also injected
intravenously to assess for plasma protein extravasation.
A second set of animals were injected with up to 20U of
BoNT-A into the prostates 1 week prior to
intraprostatic injection of 1000 M capsaicin.
Results: For the bladder experiments, intercontraction
interval (ICI) was decreased after intravesical acetic
acid (50.2% decrease, from 22.11.8 min to 11.31.8
min and 65.0% decrease, from 20.62.1 min to
7.21.5 min) in the control group at day 3 and day 7,
respectively. However, rats that received BoNT-A
showed a significantly reduced response (ICI 28.6 %
decrease, from 26.92.4 min to 18.23.1 min) to
acetic acid instillation at day 7. This effect was not
observed at day 3 (ICI 62.2 % decrease, from
26.20.9 min to 9.91.2 min). Increased CGRP
immunoreactivity was detected from BoNT-A treated
group at day 7, which was not detected at day 3. For
the prostate study, capsaicin dose-dependently induced
pain behavioral modifications: closing of the eyes, and
hypolocomotion, and induced inflammatory changes:
increase of inflammatory cell accumulation, COX-2
expression and plasma extravasation at the acute
stage, but completely recovered at 1 week. BoNT-A
pretreatment dose-dependently reversed pain behavior
and inflammation. BoNT-A 20U significantly
decreased inflammatory cell accumulation, COX2
expression, and Evens blue extraction (82.1%, 83.0%,
and 50.4%, respectively), and reduced pain behavior
(66.7% for eye score and 46.5% for locomotion
score).
Conclusions: Intravesical BoNT-A administration
blocked the acetic acid-induced bladder pain
responses and inhibited CGRP release from afferent
nerve terminals. Protamine pretreatment allows liquid
BoNT-A to be physiological effective. These results
support clinical application of BoNT-A for the
treatment of PBS/IC. Intraprostatic capsaicin injection
induced neurogenic prostatitis and prostatic pain and
may be a useful research model. BoNT-A pretreatment
produced anti-inflammatory and analgesic effects and
support clinical evaluation in nonbacterial prostatitis.
7. Effect of changes of detrusor-original excitability
on the overactive detrusor
Bo Song, Longkun Li, Xiyu Jin, Qiang Fang, Gensheng Lu, Weibing
Li
Urological center, Southwest Hospital, Third Military Medical
University, Chongqing, PR China
Background: Overactive detrusor is due to an un-
inhibitable detrusor contraction during bladder storage,
which always occurs in the pathologic changes such as
bladder outflow obstruction and neurogenical bladder.
The mechanism is still not well clarified and several
hypotheses are presented , the most popular one is the
neurogenical theory. Unfortunately the antimuscarinic
drugs are not always satisfactory for overactive detrusor
according to this theory. Besides the integrity innervation,
is there any myocyte-original regulation on the bladder
excitability, like in the heart or the intestinal organs?
Detrusor-original regulation on the bladder excitability
must have such characteristics: spontaneous excitability
even undergone denervation; existence of cell-to-cell
excitability transconduction; peacemaker cells or
peacemaker spots initiating the excitability. To our
knowledge, there are few reports on it.
Materials and methods: Three kinds of rats models with
normal, super-sacral spinal cord transsection and posterior
urethral obstruction were constructed, the overactive
detrusor from the super-sacral spinal cord trans-section
and the posterior urethral obstruction models were
selected for the studies. 1) The frequency and intensity of
the detrusor spontaneous contraction were evaluated with
cystometry in vivo, whole-bladder cystometry in vitro,
and detrusor muscle strip test in vitro. The effect of the
activators of autonomic nerves on the three models were
accessorily detected. 2) The gap junctional intercellular
communication in the overactive detrusor was observed
with fluorescent bleach technique. 3)To find out the
interstitial cells of Cajal (ICC)-like cell with
histochemistry, which may behavior as the peacemaker in
gastrointestinal. The action potential of the ICC-like cell
was also studied with patch-clamp.
Results and Conclusions: 1) The stretch load which can
induce the contraction in overactive detrusor was much
less than that in normal detrusor, but with no significant
difference between the overactive detrusor models in
neurogenic and bladder outflow obstruction; the activators
of autonomic nerves were effective on the frequency of
detrusor-original contraction secondary to the stretch load,
but cannot eliminate the contraction. Moreover, even
tetrodotoxin cannot eliminate the stretch-induced
spontaneous detrusor contraction. 2) The gap junction
can transfer the cell-cell communication, and this
function was enhanced in overactive detrusor
myocytes, which indicated the existence of the
detrusor-original gap junctional intercellular
communication. 3) ICC-like cell exists in bladder, and
with the similar potential characteristic as the heart
peacemaker, which implied a potential peacemaker in
bladder excitability.
Prospect: Bladder excitability is always thought as
one thing between the autonomic and non-autonomic.
Our series of studies verified the existence of detrusor-
original element in excitability regulation, and also
verified the importance of detrusor-original excitation
in the occurrence of overactive detrusor. But the role
of detrusor-original excitability in normal bladder still
need further studies.
8. Bladder primary sensory neuron block: animal
and clinical application
Zhichen Guan M.D.
Department of Urology, Peking University Shen Zhen Hospital,
China
Objective To study the role of primary sensory
neurons block using intravesical vanilloids (capsaicin
and resiniferatoxin) both in animal and human.
Material and Method From 1994 to 2004, six
studies using 27 dogs and 123 rats were done to
evaluate the urodynamic, neurotransmitter (substance
p) and histological changes after bladder instillation of
Capsaicin. Consequently, three studies including 102
patients were carried out using intravesical capsaicin
or resiniferatoxin (RTX). The intravesical
concentration of capsaicin was 1uM – 2MM/L and
RTX was 100nM /L.
Result During the first 35 minutes, multiple
spontaneous bladder contractions were elicited in
85.71% and 50% of dogs after 100 uM and 1 uM
capsaicin bladder instillation, respectively. A
significant increase in the bladder volume at leakage
point (82.93+3.51 cc vs. 122.22+11.32 cc) was noted.
The SP concentration was 2.88+0.55pg/g in control
group and the SP concentration were 1.54+0.25 pg/g
and 1.29+0.16 pg/g in 1 uM and 100 uM groups after 12
weeks bladder instillation, respectively. Capsaicin
reversibly abolished the bladder instability, improved
bladder function and increased the ability to compensate
in rats with partial bladder outflow obstruction. In a study
of 30 OAB cases, RTX instillation didn’t cause vesical
irritation and no local anaesthesia was required. The
symptoms were improved immediately in all the patients
after 1 day of RTX intervention. The decreases in both
diurnal (5 to 15 times, mean 8.9 times) and nocturnal (0 to
5 times, mean 3.0 times) frequencies were significant
(p<0.001) according to voiding diaries at 1 week and 1
month after treatment.
Conclusion The experimental and clinical evidence
demonstrated that vanilloids regulated the volume
threshold for eliciting micturition reflex, improved
bladder response to partial bladder outflow obstruction,
had long lasting effects on overactive bladder resulting
from a variety of reason. RTX, which produced both an
immediate and a prolonged desensitization, appeared to
be less irritating than capsaicin and it may be more useful
clinically.
9. Pyeloplasty: retroperitoneal laparoscopic vs. open
approaches
Xu ZHANG*, Hong-Zhao LI, Xin MA, Tao ZHENG, Bin LANG, Jun
ZHANG, Bin FU, Kai XU
Departments of Urology, Tongji Hospital (XZ, XM, BL, JZ, BF, KX),
Tongji Medical College, Huazhong University of Science and
Technology, Wuhan 430030, Xiangya Hospital of Central South
University (HZL), Changsha and Xiangfan Central Hospital (TZ), Tongji
Medical College, Huazhong University of Science and Technology,
Xiangfan,.
Purpose: We evaluated the clinical value of
retroperitoneal laparoscopic dismembered pyeloplasty for
ureteropelvic junction
obstruction compared with open surgery.
Materials and Methods: The clinical data of 56 patients
who underwent retroperitoneal laparoscopic dismembered
pyeloplasty were retrospectively compared with those of
40 patients who underwent open dismembered
pyeloplasty through a retroperitoneal flank approach.
Student t-test, Pearson Chi-square test and Mann-Whitney
rank sum test were applied for statistical analysis as
appropriate.
Results: Patient's demographic data were similar
between the two groups. In the laparoscopic group,
operative time (80 vs 120minutes), estimated blood
loss (10 vs 150mL), recovery of intestinal function (1
vs 2days), analgesic requirements (75 vs 150mg),
incision length (3.5 vs 21cm), and postoperative
hospital stay (7 vs 9days) were better than in the open
group (p<0.001 for all). No intraoperative
complications occurred in either group. The incidence
of postoperative complications (2 of 56, 3.6% vs 3 of
40, 7.5%, p =0.729) and success rates (55 of 56,
98.2% vs 39 of 40, 97.5%, p = 0.058) were equivalent
in the 2 groups.
Conclusions: Retroperitoneal laparoscopic
dismembered pyeloplasty is a minimally invasive, safe
and effective therapy for ureteropelvic junction
obstruction with low morbidity, shorter convalescence
and excellent outcomes and can be accomplished
reasonably quickly in experienced hands.
10. Graft Outcome of Living Donor Renal
Transplantation in the Elderly Recipients
Feng-Pin Chuang 1,2, Andrew C Novick 1, Guang-Huan Sun 2,
Michael Kleeman,Stuart Flechner 1, V. Krishnamurthi 1,Charles
Modlin 1, Daniel Shoskes 1 , David A.Goldfarb 1
1 Glickman Urological Institute, Cleveland Clinic Foundation,
Cleveland, Ohio, USA;2 Division of Urology, Department of
Surgery, Tri-Service General Hospital, NationalDefense Medical
Center, National Defense College, Taipei, Taiwan, R.O.C.
Background. Living donor renal transplantation is a
treatment option for patients on dialysis in view of the
ever-growing transplantation waiting lists and the
stagnation in the number of deceased donors. In the
past, advanced age has been considered to be not a
good candidate for living donor renal transplantation.
The aim of this study is to
analyze whether old age affects the outcome of living
donor renal transplantation.
Methods. 527 first-time living donor kidney
transplants were performed between January 1, 1995
and January 1, 2006. The patient population was
divided into two subgroups base on the patient’s age at
the time of transplant. Old patients were all recipients
age 60 years old and above at time of transplant; the
control group was all other patients.
Results. There is a significant difference in readmission
rate (p= 0.031) and patient survival rate (p< 0.001)
between two groups. There is not a significant difference
in graft survival rate (p=0.808), acute rejection rate (p=
0.7), serum creatinine level and length of stay between
these two groups (t=1.75, p=0 .083).
Conclusions. Living donor renal transplantation has been
controversial in elder recipients. From the clinical
reviews, our results confirm that many older patients may
benefit from living donor renal transplantation.
11. Laparoscopic repair of injury to the inferior vena
cava-report of three cases (Video)
Liqun Zhou*, Zhisong He, Ningchen Li, Ming Li..
Department of Urology, Peking University First Hospital
The Institute of Urology, Peking University
8 Xi Shi Ku Street, West District, Beijing 100034, China
Introduction and Objective: During laparoscopic
surgery, the injury to large vessels, such as inferior vena
cava (IVC), often leads to open procedure for repair to
avoid bleeding in large amount. We report our primary
experience of 3 cases to repair IVC injury
laparoscopically and evaluate the safety and efficacy of
such laparoscopic repair.
Methods: From March of 1992 to August of 2006, we
have done 1,668 cases of laparoscopic procedures and
met 3 cases (0.18%) of IVC injury, which were partial
adrenalectomy, radical nephrectomy and radical
ureteronephrectomy. These injuries were caused by
dissection with electrocautery hook and harmonic scalpel
and 1.2cm, 0.2 cm (2 0.2cm fissures in 1 case) and 0.5cm
in length respectively. We repaired the fissures of IVC
laparoscopically with intermittent sutures of 3-0 Vincryl
threads. The key point for suturing is to work in suction
and needle holder in order to show the fissures clearly and
suture them accurately.
Results: All 3 cases were repaired successfully under
laparoscopy and needed 4, 2 and 1 suture respectively. It
took 21, 13 and 11 minutes and the amount of bleeding
was just 120, 80 and 65ml for repair separately. One case
developed partial unconsciousness, language and arm
disability after operation and computerized tomography
showed several small infarction foci in brain, which
might be caused by gas embolism. She recovered full
consciousness 1 week later and normal language and
arm ability 6 weeks later, but remained the intermittent
and slight headache for 3 months. Other 2 cases had
no complications. There may be no bleeding at all
when IVC injury just occurs and can’t be found in
time due to much higher pressure used for
pneumoperitonium (14mmHg) than that of IVC
(12cmH2O). It would make more gas enter into IVC
and gas embolism develop, which is more dangerous
for patient.
Conclusion: Laparoscopic repair of IVC injury is safe
and effective on skilled hands. The earlier the injury is
found and repaired, the less complications the patient
develops.
12. Retroperitoneal laparoscopic Radical
Nephrectomy and regional lymphadenectomy
for Renal Cell Carcinomas
Wei Zhang, Changjun Yin, Wei Zhang, Min Gu, Xiaoxin Meng,
Qiang Lv, Lixin Hua, Zhengquan Xu, Yuangeng Sui
Department of Urology, The First Affiliate Hospital of Nanjing
Medical University, Nanjing 210029, China
Objective: To investigate the feasibility and the
clinical application value of the retroperitoneal
laparoscopic radical nephrectomy and regional
lymphadenectomy of renal cell carcinoma (RCC).
Methods: Between July 2000 and May 2006, 242
patients (159 males and 83 females) underwent
retroperitoneal laparoscopic radical nephrectomy of
RCC, of which 58 cases also underwent regional
lymphadenectomy.
Result: All cases finished successfully. The mean
operation time was 170 min (range from 150-200
min); the mean blood lose was 150 ml (range from
100-170 ml); the mean tumor diameter ranged from 3-
7cm. No case of local or systemic relapse or adrenal
metastases, but three cases of lymph node positive and
five cases of homonymy adrenalectomy were
observed by a follow-up of 1-5 years. Conclusion:
The retroperitoneal laparoscopic and open radical
nephrectomy of RCC can achieve the same effect, and
the former has the advantages of minimal invasion and
quicker recovery; however, the former should obey the
same operative principle with the latter.
13. Correlation of COX-2 Expression in Stromal Cells
with High Stage, High Grade and Poor Prognosis
in Urothelial Carcinoma of Upper Urinary Tracts
Chih-Hsiung Kang, Po-Hui Chiang, Shun-Chen Huang*, and Hsuang-
Lan Yu
Department of Urology and *Pathology, Chang Gung Memorial
Hospital, Kaohsiung Medical Center, Chang Gung University, Taiwan
Introduction: To investigate cyclooxygenase-2 (COX-2)
expression in carcinoma and stromal cells in patients with
urothelial carcinoma of upper urinary tracts (UCUUT),
and determine whether expression patterns are associated
with clinical characteristics and survival.
Methods: Immunohistochemistry for COX-2 was
performed on paraffin embedded tumors from UCUUT
specimens from 79 patients. The level of expression in
carcinoma cells, the presence of stromal cell expression,
and the infiltration of inflammatory cells were evaluated.
Results: Strong and moderate expression of COX-2 in
carcinoma cells was observed in 19 (24.1%) and 46
(58.2%) cases, respectively. In 36 (45.6%) cases COX-2
expression was present in stromal cells. The level of
COX-2 expression in carcinoma cells was not correlated
with pathological stage ( P = 0.22), and not with grade (P
= 0.45). COX-2 expression in stromal cells was correlated
with high stage (P < 0.0001) and high grade (P < 0.0001).
The patient’s survival was reduced if the tumor revealed
strong or moderate expression of COX-2 in carcinoma
cells (P = 0.03), the presence of COX-2 expression in
stromal cells (P < 0.0001), and infiltrating inflammatory
cells (P = 0.0001) by log rank test. Prognosis was poor if
the tumor was positive for both COX-2 expression in
stromal cells and inflammatory cell infiltrate (P <
0.0001).
Conclusion: COX-2 expression in stromal cells shows
greater correlation with high stage and high grade than
strong COX-2 expression in carcinoma cells. It is
suggested that stromal COX-2 expression could be used
as a marker of poor prognosis in patients with UCUUT.
14. Endoluminal Ureteroplasty for Ureteroenteric
Stricture – A Feasibility Study In Porcine
Model
Victor Chia-Hsiang Lin1, Allen W. Chiu2, Mihir M. Desai3, Inderbir
S. Gill3
1E-Da Hospital/I-Shou University, Kaohsiung, Taiwan, 2Chung-
Hsiao Mucinipal Hospital, Taipei, Taiwan, 3Cleveland Clinic,
Cleveland, USA
Introduction: We describe a novel technique of
endoluminal endoscopic ureteroplsty for
ureteroenteric stricture in which the conventional
longitudinal incision is precisely repaired by sutures
via the stoma of ileal conduit in a survival porcine
model.
Method: Under general anesthesia, totally 9 farm pigs
underwent laparoscopic cystectomy and ileal conduit.
Left ureteroenteric stricture was created by an
additional suture near the ureteroenteric junction. 3-4
weeks later, these 9 pigs received endoluminal
ureteroplasty. The first 3 pigs underwent the
procedures in acute setting to establish and standardize
the optimal technique. The latter 6 pigs underwent the
operation in chronic setting and were sacrificed 4
weeks later. The serum creatinine, electrolyte,
intravenous urography and loopgram were performed
before reconstruction and before euthanasia. The
tissue near ureteroenteric junction was sent for
histopathologic exams.
Result: The mean operation time for laparoscopic
cystectomy and ileal conduit were 291.7 minutes. The
mean operation time for endoluminal ureteroplasty
was 60 minutes. Intravenous urography before
reconstruction revealed left hydronephrosis and
hydroureter in all 6 pigs with significant in 3,
moderate in 2 and mild in 1. After correction, all the 6
pigs revealed patent ureteroenteric junction on
loopgram. However, 2 pigs had complication of ileal
stoma stenosis.
Conclusion: Endoluminal endoscopic ureteroplasty is
technical feasible, safe and effective. The merits of
minimal invasiveness can be maintained without the
need of new incision and the good full-thickness
healing with primary intent, minimal urinary
extravasation can be achieved. We believe the techniques
can be spread to human surgery in the near future.
15. Laparoscopic Radical Nephroureterectomy With
Concomitant Radical Cystectomy for Multi-Focal
Transitional Cell Carcinoma in Uremic Patients:
Initial Experience
Victor C. Lin1, Allen W. Chiu2, Y. H. Lee3, T. J. Yu1
1E-Da Hospital/I-Shou University, Kaoshiung, 2Chung-Hsiao
Municipal Hospital, Taipei, 3Chi-Mei Medical Center, Tainan, Taiwan
Introduction: Transitional cell carcinoma (TCC) is the
most common urinary tract cancer in patients on dialysis
in Taiwan. It tends to be multi-focal, high recurrent, and
intolerant to chemotherapy and radiotherapy. We present
our experience of one session en-bloc laparoscopic
unilateral or bilateral nephroureterectomy with radical
cystectomy to treat multifocal TCC in uremic patients.
Method: 7 uremic patients who were diagnosed
multifocal TCC were enrolled. 4 patients were male and 3
patients were female. 5 had undergone ipsilateral
nephroureterectomy or radical nephrectomy due to
previous history of unilateral upper tract cancer. These 5
patients underwent laparoscopic unilateral
nephroureterectomy and concomitant radical cystectomy
due to multifocal recurrence of urothelial carcinoma. The
other 2 female patients had simultaneous upper tract and
bladder TCC in the first time diagnosis and both
underwent one session laparoscopic bilateral
nephroureterectomy with concomitant radical
cystohysterectomy. 6 trocar ports were used in our series.
Bilateral nephroureterectomy was performed under lateral
position by turning the operation table and the cystectomy
was performed under the Tredelenberg position. The
specimen was retrieved either from vaginal route in
female patients or from old scar or midline in male
patients.
Result: Mean time for unilateral nephrectomy was 90
minutes. Mean time to complete radical cystecotmy with
prostatectomy or hysterectomy was 147 minutes. Mean
blood loss was 530 ml. Mean postoperative hospital stay
was 7 days.
Conclusion: In our initial experience, laparoscopic
nephroureterectomy with concomitant radical cystectomy
for multifocal TCC in uremic patients is a technically
feasible, safe and efficacious modality.
16. Prostate cancer management consensus and
guidelines between china and taiwan
Chih-cheng Lu, Chia-Ho Lin, Dennis Chian-Shiung Lin, Eric W.
Fan, Tse-Chou Cheng
Divisions of Urology, Department of Surgery, Chimei Foundation
Hospital, Liouying, Tainan, Taiwan
Purpose: To compare the clinical practice guidelines
in managing prostate cancer(CaP) between China and
Taiwan.
Materials and Methods: The printed and online
materials in medical guidelines or consensus for CaP
by Chinese Urological Association(CUA), and Taiwan
Cooperation Oncology Group(TCOG) were reviewed.
It consisted of published date, revision history,
diagnostic methods, and especially the treatment
options.
Results: The online guidelines for CaP by CUA were
available since July, 2006. The TCOG had the first
edition of CaP practice guidelines since 1999, and the
second edition in 2003. While China version was
made by CUA, the Taiwan version was by
interdisciplinary experts in TCOG. Magnetic
resonance image (MRI) was suggested before
transrectal prostatic biopsy in China but not in TCOG.
Both agreed to start checking prostate specific
antigen(PSA) level when the patient was 45 year-old
with a family history of CaP or 50 year-old. PSA
normal range was based on Chinese people data with
age specific consideration by CUA and based on USA
data by TCOG. In predicting local staging and lymph
nodes, MRI was considered more informative by CUA
than TCOG. The staging system was based on AJCC
2002 by CUA and AJCC 1997 by TCOG, respectively.
At least there were no T2c in AJCC 1997 edition. In
treatment, HIFU(high intensity focused ultrasound)
and CSAP(cryo-surgical ablation of the prostate) was
informed by CUA only. Hormone refractory CaP was
clearly defined with biochemical data by CUA and
mainly based on clinical condition by TCOG. Neither
CUA nor TCOG suggested phytotherapy as an option
of treatment.
Conclusions: In this limited study, we demonstrated
several varieties in the guidelines between both regions.
Urologists should be aware of the differences between the
Chinese versions when applying CaP guidelines to
evaluate the Mandarin speaking patients with prostate
cancer.
17. The Guidelines or Consensus in Managing Benign
Prostatic Hyperplasia among China, Singapore
and Taiwan
Chih-cheng Lu, Chia-Ho Lin, Dennis Chian-Shiung Lin, Eric W. Fan,
Tse-Chou Cheng
Divisions of Urology, Department of Surgery, Chimei Foundation
Hospital, Liouying, Tainan, Taiwan
Purpose: To analyze the updating guidelines or
consensus in managing benign prostatic hyperplasia
(BPH) around the Asian Chinese. It included China,
Singapore and Taiwan.
Materials and Methods: The printed and online
materials in guidelines or consensus for BPH by Chinese
Urological Association(CUA), Singapore and Taiwanese
Urological Association(TUA) were reviewed. Several
statements were compared including published date,
revision history, any Chinese translation version, patient
selection, diagnostic methods, and treatment options.
Results: The online guidelines for BPH by CUA were
available before August 2006. The TUA had the Chinese
translation(complex characters) of International Prostate
Symptom Score(IPSS) and consensus of combination
medical therapy in February and May 2006, respectively.
The earliest Chinese version of IPSS was published by
Ministry of Health of Singapore. Both of the Chinese
version by CUA and Singapore were written in simplified
characters. Neither CUA nor TUA interpreted precisely
IPSS, which consists of 8 questions. The summed score 0
to 35 is from the 7 urinary indexing symptoms. Among
these Chinese editions of IPSS, only the translated title
was the same. The following 7 urinary symptoms
indexing questions and the eighth question about quality
of life were semantically different. Only in the guidelines
by Singapore established trans-abdominal prostatic
grading and staging systems for BPH as non-invasive
methods for evaluation and treatment. Either trans-
abdominal or trans-rectal route for sonography was
accepted by all. The Age over 50 was announced suitable
for guidelines both in CUA and Singapore. There were
documented industrial support in building the
guidelines or consensus; it was Merck for CUA and
Yamanouchi(now as Astellas) for TUA. The CUA
considered 5-alpha reductase inhibitors as options of
the first line therapy; while the TUA restricted them to
be the second line therapy. The use of 5-alpha
reductase inhibitors by TUA was not compatible with
the rules set by National Health Insurance of Taiwan.
Long term of phytotherapy for clarification was
suggested by CUA and Singapore while no consensus
was done by TUA.
Conclusions: Mandarin is currently used without
significant difficulty around these regions. People are
traveling and communication more and more; the
urologists should be aware of the differences among
the Chinese versions when applying IPSS to evaluate
the Mandarin speaking patients. Also, this updating
comparison could do some help in establishing the
practice guidelines, which is unpublished, in
managing BPH by TUA, since the consensus remains
fragmented.
18. Hemospermia Associated With Prostatic Cysts:
Diagnosised by Transrectile Ultrasonographic
and Endocrectal Coil MR Imaging
SONG Wei-dong, XIN Zhong-cheng, ZHANG Zhi-chao, GAO Bing,
TIAN Long, LIU Bao-xing, WU Yi-guang, WU Xiao-jun, GUO Ying-
lu
Andrology Center, Peking University First Hospital, Peking
University,Beijing(100009), China
Objective: Hemospermia often associated with
prostate cysts or perioprostatic tissues the radiological
diagnosis of prostatic or periprostatic cysts could be
an ideal methods for define the relationship of a cyst
to surrounding structures, such as the vas deferens,
seminal vesicles, and ejaculatory ducts. To evaluate
the role of transrectal ultrasonography (TRUS) and
endorectal coil MR in the diagnosis of hemospermia
associated with prostatic cysts.
Methods: One hundred twenty patients with
hemospermia were performed transrectal ultrasound
between August 2005 and March 2007, and 28 cases
(23.3%) were found medical prostatic cysts, among of
them 24 cases were further evaluated clinical symptoms
and performed endorectal coil MR.
Results: Of the 24 men, 16 (67%) complained of
prostatitis-like symptoms, 12 (50%) with scrotal pain, 7
(29%) with small volume ejaculation, and 5 (21%) with
painful ejaculation. All patients had normal follicle
stimulating hormone levels, normal or low fructose levels
in the seminal fluid. On the basis of MR imaging
appearance, 18 (75%) had no anatomic ejaculatory duct
abnormalities. Of the remaining patients, 4 (17%) had
seminal vesicle dilatation, 2 (8%) had seminal vesicle
hypoplasia. Prostatic cysts are easily identified on MR
imaging by virtue of their high signal on T2-weighted
images and can be characterized because of their typical
locations and the high resolution and multiple imaging
planes provided by MR.
Conclusion: With these results suggested that TRUS and
endorectal coil MR are important non-invasive diagnostic
tools that minimize the need for more invasive studies in
the evaluation of hemospermia, particularly when
associated with prostatic cysts. TRUS and endorectal coil
MR were not only helpful in establishing the diagnosis
but also in determining the choice of treatment.
19. China Experience of Penile Prosthesis
Implantation for Sever Erectile Dysfunction
Zhong Cheng Xin, Zhi Chao Zhang, Wei Dong Song, Long Tian
Andrology Center of Peking University First Hospital, Peking
University, Beijing(100009),China
Purpose: In order to evaluate the effects of different kinds
of penile prosthesis implantation for Chinese patients with
sever erectile dysfunction (SED).
Subjects and methods: Total 98 cases of Chinese
patients with SED were treated by different kinds of
penile prosthesis implantation during Oct. 2001-Jan. 2007
were followed up using questionnaire form. Mean age of
patients was 33.410.6 years old and duration of SED
was 5.54.5 years. Among of them the vasculargenic
SED was 63 cases (64.3%), neurogenic ED was 20 cases
(20.4%), DM 10 cases(11.2%), Peyronine’s disease 4
cases(4.1%). Three piece penile prosthesis AMS700 CXM
for 69 cases(70.4%) and Manto alpha I for 3 cases(3.1%)
and AMS 650 malleable prosthesis 26 cases(26.6%).
Among of them, 3 cases were performed one stage
implantation of AMS700CXM with visual internal
urethrotomy. Patients and partner’s satisfaction with
penile prosthesis implantation were followed up with
questionnaires form.
Results: Among of patients 2 cases (2.0%)
mechanical malfunction, 1 case mechanical
malfunction with tube rupture in DM patients with
sever cacernosum fibrosis was reimplanted AMS650
malleable and I case malfunction with fluid leakage,
however, the patients was satisfied with oral
medication with PDE5i such as Sildenafil, Tadanafil
and Vardenafil. Patients and partner’s satisfaction with
penile prosthesis implantation were 92.4% and 89.8%.
Conclusion: Different kinds of penile prosthesis
implantation was ideal methods for treatment of SED
in Chinese patients, and one stage implantation
AMS700CXM with visual internal urethrotomy seams
safe and effective method for treatment of SED with
urethra stricture.
20. Sural Nerve Grafting During Laparoscopic
Radical Prostatectomy---Initial experiences of
two patients
Xin Gao, Xiaopeng Liu, Jianguang Qiu, Hengjun Xiao, Tujie Si
Dept. of Urology, the Third Affiliated Hospital of Sun Yat-sen
University, 510630, Guangzhou, China.
Introduction and Objectives: Sural nerve grafting
for patients undergoing radical prostatectomy (RP) has
been previously reported using open and robotic
laparoscopic methods. We report our initial
experiences with sural nerve interposition during
laparoscopic radical prostatectomy (LRP).
Methods:Between April and July 2005, two potent
men were underwent sural nerve grafting during LRP
in our department. The age of patient was 59 and 61,
respectively. A plastic surgery team harvested 10 to 15
cm of sural nerve from the left leg. The neurovascular
bundles (NVB) were extensively excised in left side of
patient 1 and both sides of patient 2. With the hem-o-
lock located the stump of NVB, sural nerve
interposition was performed using 2 stitches of each
end with 6-0 polypropylene. Postoperative sexual
rehabilitation included oral small dosage of sidenafil
(25mg/d) after catheter removed and intracavernosal
injection of PGE1 10-30μg, once weekly, which helped
the penile engorgement occasionally. Postoperative
potency was defined as the ability to penetrate and
complete sexual intercourse with or without the use of
oral agents. The follow-up was 14-18 months. Patients’
potency was evaluated with IIEF-5 and NPT test by
Rigiscan.
Results:The sural nerve grafting through LRP was
performed successfully in both patients with mean
operating time of 5.5 hours. During a follow-up of 6
months, both patients reported penile engorgement with
sidenafil but not sufficient for penetration. At the 12 th
month, patient 1 reported spontaneous erection without
any help, erectile number was 1-2/night, erection time
was 13±3.5min (70-80%rigidity or greater). Patient 2 was
potent enough to penetrate with oral sidenafil, erectile
number was 0-1/night, and the erection time was
25±6.5min (20-40%rigidity).
Conclusions:Sural nerve graft interposition during LRP is
technically feasible and benefits for postoperative
erection. Post-operative sexual rehabilitation is safe and
useful for potency recovery.
21. Erectile Dysfunction Following Transurethral
Electrovapor Resection for Different Sized
Prostates
Chih-Kuang Liu1, 3, Ming-Chung Ko1, 3, Huey-Sheng Jeng1, 2, Wen-Kai
Lee1, Hong-Jeng Yu2, Han-SunChiang3
1Department of Urology, Taipei City Hospital, 2Department of Urology,
National Taiwan University Hospital, 3College of Medicine, Fu-Jen
Catholic University, Taipei, Taiwan
Objective: To assess and compare the relationship
between erectile function and intraoperative rectal
temperature changes of potent patients with different
prostate sizes undergoing transurethral electrovapor
resection treatment (TUVRP).
Patients and Methods: 86 potent patients with lower
urinary tract symptoms (LUTS) secondary to benign
prostatic hyperplasia (BPH) were recruited. Patients were
divided to group1-small prostates (＜40 ml), and group 2-
large prostates ( 40 ml) as determined by transrectal≧
ultrasound (TRUS) measurement. The intraoperative
rectal temperature was evaluated by transrectal
thermosensor and the temperature differences (the
highest intraoperative temperature minus the
preoperative temperature) were recorded. The erectile
function at baseline, 3 months and 1 year
postoperatively were assessed by the International
Index of Erectile Function-5 (IIEF-5) Questionnaire.
Results: The intraoperative rectal temperature
differences were 0.54±0.24 ℃ in the group 1 (n=45)
versus 0.44±0.20 ℃ in the group 2 (n=41), (p=0.04).
The erectile function data were available for 84 and 78
patients at 3 and 12 months, respectively. The IIEF-5
scores were 20.9±1.6 (group1) versus 20.6±1.6 (group
2) at baseline (p=0.32), 17.3±2.9 versus 18.7±3.2
(p=0.037) at 3 months, and 17.9±2.7 versus 18.7±3.0
(p=0.17) at 1 year postoperatively, respectively. The
deterioration of erectile function at baseline and 3-
month postoperatively were observed (p＜0.001) for
both groups. The percentage of retrograde ejaculation
between two groups were not significant (p=0.33) at
3-month postoperatively.
Conclusions: Our study reveals that higher
intraoperative rectal temperature difference caused by
transurethral electrovapor resection for treatment of
symptomatic prostatic hyperplasia might affect the
postoperative erectile function, particularly in a small
prostate.
22. A Mode Of Treatment For Penilie
Incarceration – An Unusual Complication Of
Masturbation
Jesun Lin, Gin-Bow Chang, Herng-Jye Jiang, Mon-I Yang,
Huai-Long Tai,and Bai-Fu Wang
Department of Urology, Changhua Christian Hospital,
Changhua, Taiwan
Purpose: We investigated a technique for releasing
an incarcerated penis from the hole of a thick steel
plate with minimal invasion.
Material and Methods: The patient had his penis
incarcerated in a 2 cm diameter hole with 2 cm thick
steel plate. We aspirated the congested blood from the
glans penis and incised the edema and ecchymosis
prepuce to facilitate the escape of subcutaneous
congestion blood and fluid. A rubber band was wrapped
around the penile shaft immediately distal to the thick
steel plate. A fine mosquito hemoclamp was then inserted
to grasp the end of the rubber band through the hole. The
thick steel plate was gradually worked along the penile
shaft until it was free from incarceration.
Results: This mode can be used to release the penis from
incarcerating objects in emergency situation. The method
can be performed in an operating room with minimal
equipments and simple technique. The penis is able to
sustain very little injury.
Discussion: The penile incarceration in a thick steel plate.
It is impossible to cut the thick steel without injury of the
penis in an emergency state. The patient has been
followed up for more than ten years and no any deficit in
sexual or urinary condition.
Conclusion: We recommend this procedure for the
treatment of penile incarceration in similar conditions
because it is simple and effective.
23. Effect of Cox7a2 on LH induced testosterone
production and expression of StAR protein,
P450scc and 3β-HSD enzymes in TM3 mouse
Leydig cells
Liang Chen, Zhong-Cheng Xin，，Long Tian, Yi-Ming Yuan, Gang Liu
, Ying-Lu Guo
Andrology Center, Peking University, First Hospital, Peking University,
Beijing 100009, China
Objective: The cloning of Cox7a2 one respiratory chain
related gene showed highly expressed in aging male testis
tissue in previous study and the effect of Cox7a2 on
steroidogenesis and the involved mechanism was
investigated.
Methods: In the present study, TM3 cells are over-
expressed Cox7a2 by transient transfection of
recombinant Cox7a2 cDNA plasmid. LH-induced
testosterone production is observed by ELISA, and the
expression of StAR, P450scc and 3β-HSD was
investigated by Western blotting in TM3 cells over-
expressing Cox7a2 fusion protein.
Results: Cox72 inhibited the LH-induced testosterone in
TM3 mouse Leydig cells. In the results of Western
blotting, the expression of StAR protein decreased in
TM3 cells over-expressed Cox7a2, but the expression of
P450scc and 3β-HSD did not altered obviously.
Conclusion: Data presented here reveal an unknown
role of Cox7a2 in the regulation of the expression of
StAR protein, and in its consequent mediating
androgen biosynthesis. In TM3 cells, the negative
regulatory effect of Cox7a2 on steroidogenesis is, at
least, a result of the decreased expression of StAR
protein.
24. Association of the phenotype of seminal
vesicles and CFTR gene mutation in the
patients with congenital bilateral absence of
the vas deferens
Chien-Chih Wu1,2, Chia-Hung Liu2, Han-Sun Chiang1,3
1Department of Urology, School of Medicine, Taipei Medical
University, Taipei, Taiwan
2Department of Urology, Taipei Medical University Hospital,
Taipei, Taiwan
3Fu Jen Catholic University, Taipei, Taiwan
Purpose: Cystic fibrosis (CF) is caused by the
mutation of cystic fibrosis transmembrane
conductance regulator (CFTR) gene; different
composition of the mutated genes resulted in varied
degrees of anomaly in phenotype. Among these,
congenital bilateral absence of the vas deferens
(CBAVD) is recognized as a mild form of CF. Besides
the defect of bilateral vas deferens in CBAVD
patients, there are various anomalies in the expression
of seminal vesicles, including agenesis, hpoplasia, and
even normal expression. This study is to analyze the
association of seminal vesicle phenotype and the
mutation spectrum of CFTR gene in CBAVD patients.
Materials and Methods: DNA samples were
collected from 20 CBAVD patients. Temporal
temperature gradient gel electrophoresis (TTGE)
followed by DNA sequencing was used to screen
CFTR mutation for all collected DNA samples, which
were then classified into homozygous (the same
mutations both in 2 alleles), compound heterozygous
(2 different mutations separately in each allele),
heterozygous (one mutation in one of the 2 alleles),
and wild (no mutation detected in both alleles).
Transrectal ultrasound was applied for these 20
CBAVD patients to record the phenotype of the seminal
vesicles, the results were classified into agenesis,
hypoplasia, and present.
Results: The CFTR mutations were homozygous in 4 of
the patients, and their seminal vesicles showed agenesis in
2 of them (50%), hypoplasia in the other 2 (50%). The
CFTR mutations were heterozygous in 9 of the patients,
and their seminal vesicles showed agenesis in 1 (11.1%),
hypoplaisa in 7 (77.7%) and present in 1 (11.1%)
respectively. No CFTR mutation was detected in the rest 7
patients, and their seminal vesicles showed agenesis in 1
(14.3%), hypoplasia in 6 (85.7%). No compound
heterozygous mutation was detected in all 20 CBAVD
patients.
Conclusion: Our result shows that the frequency and
severity of seminal vesicles, although not statistically
significant, has the tendency to be related to the CFTR
genotype; the phenotype of seminal vesicles has the
tendency to show agenesis when CFTR mutation shows
homozygous or compound heterozygous, while the
seminal vesicles show mainly hypoplasia when CFTR
screen shows heterozygous mutation or wild.
25. Proteomic analysis of human urinary cancer
proteome using reverse phase nano-high-
performance liquid chromatography /
electrospary ionization tandem mass
spectrometry.
Tan Lia-Beng 1, Liao Pao-Chi 2 , and Guo Haw-Ran 2
Departement of Urology, God Help Hospital ,Taipou, Chai Hsien,
Taiwan 1Department of Enviromental and Occupational Health, Cheng-
Kung University, Tainan, Taiwan.
Purpose : The development of certain disease may
change contents of protein in body fluids, and these
proteins are potential markers for the diagnosis and
mechanistic research. Because urine can be easily
obtained without invasive procedures, the analysis of
proteins in urine is an ideal candidate for diagnosing
bladder cancer. The application of reverse phase nano-
high performance liquid chromatography / electrospary
ionization tandem mass spectrometry (nano-HPLC -ESI-
MS/MS) is possible to identify proteins in urine. The
purpose of this study is plan to apply this novel
technology in the diagnosis of bladder cancer.
Materials and Methods : Patients age and sex-
matched cancer and healthy urine specimens were
collected through catheterization. To concentrate
proteins and remove salts from the urine samples,
5KDa cutt-off centrifugal tube was applied for
ultrafiltration and chose multiple affinity removal
system (MARS) column to enrich protein
identification in urine. To enable us to identify
proteins otherwise undetectable due to the high
abundance of organic and inorganic substances in
urine, the urine was solubilized in TCA in acetone.
The protein pellet was resolubilized and digested by
trypsin for LC-MS/MS analysis. A nano-HPLC -ESI-
MS/MS was used to generate SELDI patterns from 16
primary transitional cell carcinoma (TCC) urine,
including 8 with sex and age-matched healthy urine
specimens. Quantitative proteomics was applied to
one urine specimen and the expression pattern was
verified by western blotting.
Results : A total of 3192 peptides, corresponding to
934 unique proteins were identified from the urine
samples, in which 60 proteins with higher confidence
levels. Three proteins, including transferring,
prostaglandin D2 synthase (PTGDS), and SET domain
and mariner transposase fusion gene (SETMAR)
identified in this study are those have not been
reported in the urine of bladder TCC before. In
addition, we found that lopocalin-type prostaglandin
D2 synthase (PTGDS) , as depressed in malignant
stages. These proteins could originate from blood
and /or bladder cancer tissue of the patients. They also
represent potential candidates of useful biomarkers of
bladder TCC and could be measured in the urine.
Further studies directed toward a multitude of possible
protective mechanisms of this enzyme in bladder
cancer are warranted.
Conclusions : Nano-HPLC -ESI-MS/MS is enables
detection of cancer-specific proteins in complex
biological mixtures such as urine. These tumor
specific urine proteins may proved to be useful for
developing a novel of non-invasive, highly sensitivity
and acceptable specificity screening tests for the
asymptomatic of early-stage bladder caner.
26. Survival Analysis of Patients with Bladder
Transitional Cell Carcinoma after Open or
Laparoscopic Radical Cystectomy
Allen W. Chiu, Thomas Y. Hsueh, Steven K. Huan1, Yi-Hsiu Huang
Section of Urology, Department of Surgery, Taipei City Hospital, Section
of Urology, Department of Surgery, Chi Mei Medical Center, Tainan1,
Department of Urology, National Yang-Ming University, Taipei Medical
University, School of Medicine, Taipei, Taiwan
Purpose: To evaluate the stage and grade specific
survival at a mean follow up of 3 years in patients with
bladder transitional cell carcinoma received open or
laparoscopic radical cystectomy
Patients and Methods: A total of 62 patients with
bladder transitional cell carcinoma treated with either
open (n=21) or laparoscopic radical cystectomies (n=41)
were enrolled in this study. Perioperative and pathological
data were collected by retrospective chart review. The
mean follow-up period was 38.4 months in open and 38.7
months in laparoscopic group. Bilateral limited pelvic
lymphadenectomy was performed in selected patients in
both groups. There were 5 patients in open and 8 patients
in laparoscopic group survived longer than 5 years.
Survival analysis with stage and grade stratification was
analyzed by Kaplan Meyer method, and the local
recurrence and distant metastasis rate were reported.
Results: The surgical mortality was 9.5% in the open and
2.4% in the laparoscopic group. The 5-year disease
specific survival of pT1 patients was 100% in the open
group while 81.8% in the laparoscopy group (p=0.329).
The 5-year disease specific survival was 60% in the open
and 72.9% in the laparoscopic group in pT2 (p=0.259)
patients. As for stage pT3, the 5-year survival was 66.7%
in the open group while 85.0% in the laparoscopic group
(p=0.269). The grade stratified survival analysis showed
no difference in patient received either open or
laparoscopic operation. The incidence of local recurrence
after the operation was 9.5% in the open group and 9.7%
in the laparoscopy group. The incidence of distant
metastasis after the operation was 9.5% in the open group
while 14.6% in the laparoscopy group.
Discussion: The value of pelvic lymphadenectomy in
open or laparoscopic radical cystectomy regarding the
similar survival analysis in this study. The stage or grade
specific survival showed no statistical significance in
patient received open or laparoscopic radical
cystectomy in a mean follow-up of 3 years. However,
a prospective study with longer follow-up is required
to verify the real role of laparoscopic radical
cystectomy for bladder cancer.
27. Characterization and Differentiation of
Human Muscle Derived Stem Cells
Shing-Hwa Lu1,2,5, An-Hang Yang3, Chou-Fu Wei2, Kuang-Kuo
Chen3,5, Luke S. Chang3,5
Department of Urology, Taipei City Hospital1;
Division of Urology3, Department of Surgery2, and Department of
Pathology4, Taipei-Veterans General Hospital;
Department of Urology, National Yang-Ming University5
Purposes: To isolate, purify, characterize and
differentiation of the human muscle derived stem cells
(MDSCs).
Materials and Methods: Isolation of human muscle
derived stem cells with modified preplate technique,
CD 34-positive stem cell isolation, invitro
differentiation of MDSCs, myogenic, adipogenic and
osteogenic induction of D 34+ cells, immunolabeling
procedures for flow cytometry, flow cytometry
analysis, immunohistochemical staining, lipid droplet
staining with Oil Red O, Alkaline phosphatase
staining, and immunofluorescence study were done.
Results: The MDSCs were isolated using modified
preplate technique and were purified using Dyna-bead
method. The growth doubling time of MDSCs was
about 45 hours. Immunohistochemical staining
showed positive for several CD markers, VCAM,
VEGFR-2, CXCR4, CD56, and Desmin staining.
Using special growth factors, the MDSCs could be
differentiated into smooth muscle, skeletal muscle,
adipocyte, and osteocyte. The differentiation was
proved by immunohistochemical study.
Conclusions: The isolation, purification,
characterization and differentiation of MDSCs were
successfully conducted. The MDSCs may provide
another novel way for the management of urinary
sphincter deficiency and bladder reconstitution.
28. Endourology in China: Current status and future
direction
Yinghao Sun, MD, PhD
Department of Urology, The 2nd Military Medical University,
Shanghai, China
During the past 30 years, the endourology in China has
been improved dramatically. For the treatment of BPH,
TUR had been introduced to China in the late 1970’s, and
now this technique has been spreaded widely in the
country as a gold standard of BPH therapy. On the other
hand, other emerging techniques for BPH treatment, such
as laser prostatectomy, have become available in general
practice outside of the investigational setting in China
during the past 10 years. On the therapy of stone,
ureteroscopy and PCN technique have been popular.
Furthermore, some new ideas have been offered, such as
the application of high power holmium laser in PCNL.
Laparoscopic nephrectomy and Laparoscopic
adrenalectomy have also been routine practice. Some
complicated operations have also been performed in the
Medical Center of metropolis, for example radical
prostatectomy, radical cystectomy and partial
nephrectomy.It is the main problem that the endourology
in china develops disparately. In some regions, such as
Peking, Shanghai, Guangzhou, et al, total technical level
is relatively high. However, in most of other regions, the
endourological technique still occupies lagging status. In
the same region, there is distinguished gap between large
medical center and basic medical institution.
In order to improve the status, Chinese urological
Association found the group of Endourology in 1985,
which goes in for spreading endourological technique and
encouraging communication. Up to date, Chinese
endourology has gained full-grown progression. We
believe that Chinese endourology should keep up with the
world in the near future.
29. Evidence-based Urology: report from China
Wei Qiang, Han Ping
Department of Urology, West China Hospital, Sichuan University,
Chengdu, P. R. China
Background: Along with progress of evidence-based
medicine, clinical medicine is undergoing transformation
from empirical medicine into evidence-based
medicine, which can not be ignored by urological
surgeons as much as other clinical physicians. To learn
and master evidence-based medicine, and to combine
the best evidence reflected by modern urologic
investigation with expertise of urologic physicians
will greatly help us to improve the clinical diagnostic
and therapeutic levels, providing patients with the best
management decisions.
Object: To introduce the current status of
popularization, application and research of evidence-
based medicine of urology in China.
Methods: Databases (including MEDLINE,
EMBASE, CBMA and Cochrane Library), journals,
guidelines and literatures were searched to extract and
analyze the information concerning research on
evidence-based medicine of urology in China.
Results: Concepts of evidence-based medicine were
popularized mainly by special theses published in
professional journals of urology in China. Since 2003,
Chinese Journal of Urology has continuously
published a series of special columns on evidence-
based medicine, systematically introducing basic
concepts and origins of evidence-based medicine, best
evidences, the relationship between urology and
evidence-based medicine, as the leading platform for
promoting and popularizing evidence-based medicine
in China. Chinese Urological Association (CUA)
organized specialists in all fields of urology of China
to systematically analyze and review relevant
domestic and international literatures according to
principles and measures of evidence-based medicine.
Based on the best results of urologic surgery, the CUA
evidence-based Guidelines on BPH, OAB, RCC and
PCA were compiled and established, which are helpful
and active for standardizing diagnostic and therapeutic
principles for common diseases in urology and
directing clinical practice of urological surgeons in
China. For studying evidence-based medicine,
together with my colleagues, we successfully
registered multiple research proposals in Cochrane
Library and published several systematic reviews and
meta-analysis in Journal of Urology, Journal of
Andrology, Asian Journal of Andrology, Chinese
Journal of Urology, Chinese Journal of Evidenced Based
Medicine, covering prevention, diagnostics and therapies
of urologic diseases as update clinical evidence for
practice in urology.
Conclusion: Great effort was made by Chinese
professionals for popularization, promotion, application
and research of evidence-based medicine in urology,
which contributed much for about 200 thousand urologic
physicians in China to perform clinical management and
improve medical treatment quality with best evidences of
evidence-based medicine.
30. The Incidence and Clinical Significance of High-
Grade Prostatic Intraepithelial Neoplasia on
Prostate Biopsy in Taiwanese Asian Men
Yen-Hwa Chang1, Yi-Chun Chiu1, Chin-Chen Pan2, Kuang-Kuo
Chen1 and Luke S. Chang1
1Division of Urology, Department of Surgery, and 2Department of
Pathology, Taipei Veterans General Hospital and Department of
Urology, School of Medicine, National Yang-Ming University, Taipei,
Taiwan, R.O.C
Purpose: High-grade prostatic intraepithelial neoplasia
(HGPIN) is considered a prostate cancer-associated
lesion. There is little information about the characteristics
of HGPIN among Asian men. We retrospectively
reviewed patients with HGPIN on prostate needle biopsy
to analyze the clinical significance of HGPIN among
Taiwanese men and to postulate the implication for
patient care.
Materials and Methods: From August 1999 to April
2004, 4250 patients who underwent transrectal ultrasound
(TRUS)-guided prostate biopsy at our hospital due to
elevated PSA and/or abnormal digital rectal examination
(DRE). Patients with HGPIN were recommended to have
follow-up biopsy unless it was rejected. Clinical
parameters and characteristics of these patients were
evaluated.
Results: A total of 112 (2.63%) had HGPIN. The mean
age at diagnosis was 73.8 years (range, 51–93). Of these
HGPIN patients, 95 (84.8%) had isolated HGPIN and 17
(15.2%) had concurrent HGPIN and prostate cancer
(PCa). 69 out of 95 (73.6%) patients with isolated HGPIN
underwent follow-up biopsy, and PCa was identified in
18.8% of patients with 92.3% of PCa detected on the first
two follow-up biopsies. There was no correlation
between clinical parameters (PSA value, DRE and
TRUS findings) and the risk of PCa on subsequent
biopsy.
Conclusions: HGPIN in Taiwanese men is uncommon
comparing to those reported in the contemporary
Western series. Clinical findings are not predictive of
PCa on repeat biopsy. If cancer is not found on the
first two follow-up biopsies, the risk of PCa is low.
These patients should then be followed up clinically to
determine whether subsequent biopsy is required.
31. Prostatic Cancer in Macau S.A.R.
Lap Hong Ian M.D
Department of Urology, Centro Hospitalar C.S. Januario, Macau
S.A.R.
Prostate cancer is the second leading cause of cancer-
related death men in the United States. The incidence
of prostate cancer in Asia is far more lower which may
be related to multiple factors including genetic, diets,
and economic environment. As the rapid economic
and social development of Asia countries and areas,
such as Macau S.A.R., in the last 10 years, the
incidence and cancer-related mortality of prostate
cancer in men are increasing markedly in trace.
Screening, early detection, improved imagiology and
surgical technology of prostate cancer are become the
major goal in Urologic Oncology in Macau S.A.R.
32. Efficacy and Safety of Tolterodine and/or
Tamsulosin in Men with Lower Urinary Tract
Symptoms (LUTS) Including Overactive
Bladder (OAB): Results from a Four-Arm,
Placebo-Controlled Trial
Zhonghong (Eric) Guan, MD, PhD
Medical Director, Global Medical, Urology, Pfizer
Background: As the storage domain of LUTS, OAB
is a syndrome characterized by urinary urgency, with
or without urgency urinary incontinence, usually with
increased micturition frequency during the day and at
night. OAB is often attributed to detrusor overactivity
(DO), a condition characterized by involuntary
detrusor contractions during bladder filling. In men,
detrusor overactivity may coexist with or be secondary
to bladder outlet obstruction (BOO) due to benign
prostatic hyperplasia (BPH). Since both BOO and DO
contribute to LUTS, it is logic to target both prostate and
bladder for the pharmaceutical intervention for LUTS
including OAB. The current standard of care for male
lower urinary tract symptoms is treatment with α-
adrenergic receptor antagonists. However, many men with
LUTS including OAB may not respond to monotherapy
with α-receptor antagonists.
Methods: This is the first study to evaluate the efficacy
and safety of tolterodine, an antimuscarinics for the
treatment of OAB, and/or tamsulosin, α-receptor
antagonist for the treatment of BPH, in men who met
research criteria for both OAB and BPH. In this
randomized, double-blind, placebo-controlled trial, men
(≥40 y) with total International Prostate Symptom Score
(IPSS) ≥12; IPSS quality-of-life (QoL) item score ≥3;
self-rated bladder condition of at least moderate bother;
and bladder diary-documented micturition frequency (≥8
micturitions/24 h) and urgency (≥3 episodes/24 h), with or
without urgency urinary incontinence were included.
Patients were randomized to placebo (n=222), tolterodine
ER (4 mg; n=217), tamsulosin (0.4 mg; n=215), or
tolterodine ER/tamsulosin (n=225) for 12 weeks.
Results: A significantly greater percentage of patients
receiving tolterodine ER/tamsulosin (80%) reported
treatment benefit by week 12 compared with placebo
(62%, P<0.0001), tamsulosin (71%, P<0.05), or
tolterodine ER (65%, P<0.01). The tolterodine
ER/tamsulosin group (vs placebo) demonstrated
significant reductions in urgency urinary incontinence
(−0.88 vs −0.31, P<0.01), urgency episodes without
incontinence (−3.33 vs −2.54, P<0.05), micturitions per
24 hours (−2.54 vs −1.41, P<0.001), and micturitions per
night (−0.59 vs −0.39, P<0.05). Tolterodine ER also
reduced urgency urinary incontinence (−0.83 vs −0.31,
P<0.01). Patients receiving tolterodine ER/tamsulosin
demonstrated significant improvements on the total IPSS
(−8.02 vs placebo, −6.19, P<0.01) and QoL item (−1.61
vs −1.17, P<0.01). The post hoc analysis found that, in
patients with larger prostate and higher PSA, only
tolterodine plus tamsulosin significantly improved
OAB/storage LUTS symptoms; however, in patients with
smaller prostate and lower PSA, tolterodine monotherapy
was almost as effective as combination of tolterodine
and tamsulosin on OAB/storage LUTS symptoms. All
interventions were well tolerated; the incidence of
acute urinary retention requiring catheterization was
low (tolterodine ER/tamsulosin, 0.4%; tolterodine ER,
0.5%; tamsulosin, 0%; placebo, 0%). Tolterodine with
or without tamsulosin did not significantly change
Qmax and PVR.
Conclusions: These results strongly suggest that
treatment with tolterodine ER with or without
tamsulosin is a safe and effective pharmacotherapy for
men with LUTS including OAB.
33. Laparoscopic Radical Cystectomy with
Orthotopic Ileal Neobladder: A Report of 85
Cases
Jian Huang2, Tianxin Lin， Kewei Xu, Hai Huang, Chun Jiang ,
Jinli Han , Yousheng Yao, Zhenghui Guo and Wenlian Xie
Department of Urology, Second Affiliated Hospital, Sun Yat-sen
University, Guangzhou 510120, China
Introduction: The preliminary results of laparoscopic
radical cystectomy in 85 cases were presented in this
study. The functional and oncological outcomes of
this procedure in these cases were discussed.
Patients and Methods: Between December 2002 and
May 2006, we performed 85 cases of laparoscopic
radical cystectomies with orthotopic ileal neobladder
for bladder cancer on 77 male and 8 female patients. A
5-port transperitoneal approach was applied. The
standard bilateral pelvic lymphadenectomy was done
first, the radical cystectomy was then completed
laparoscopically. The construction of ileal neobladder
and the anastomosis of ureter-neobladder were
performed extracorporeally. The neobladder was
anastomosed to the urethral stump under laparoscopy.
The nerve sparing procedure was performed for 8
cases.
Results: The mean operation time was 326 min, and
the mean blood loss was 316 ml. Conversion to open
surgery was not necessary for all patients. The average
time to oral intake after operation was 3.9 days. There
were no peri-operative mortalities. The complication
rate was 14.1% (12/85), including 3 uretero-pouch
anastomotic stricture, 1 vesico-urethral anastomotic
stricture, 1 pouch-vaginal fistula, 1 caceo -pouch fistula,1
ileo-pouch fistula ,3 partial ileus,1 pneumonia and 1
urinary tract infection. The daytime continence rate was
94.1 % and nighttime continence rate was 91.2 % in 6
month postoperatively. The neobladder capacity was
about 343 ml. Surgical margins were tumor free for all
cases. 4 of the 8 nerve-sparing patients had potency for
intercourse. Over a follow-up of 1 to 41 months (average
23.3 months), 3 cases had local recurrence, 1 case had
trocar site seeding, 6 cases had distant metastasis and 5 of
whom died.
Conclusions: Laparoscopic radical cystectomy with
extracorporeal formation of neobladder is a feasible
procedure with low morbidity and acceptable neobladder
function. Long term follow-up is needed to confirm the
oncological outcomes.
34. "Sliding Knot Vesicourethrostomy" in LRP and
LRC
Ho Son Fat
Urology Department, CHCSJ, Macau
Lapoaroscopy Radcal Prostatectomy and Laparoscopy
Radical Cystoprostatectomyectomy are difficult urologic
operations, and the vesicourethrostomy is the most
difficult step in these two operations, especially for the
beginner. Bsaed on continue suture method of
vesicourethrostomy, I created "Sliding Knot
Vesicourethrostomy" method. I have used "Sliding Knot
Vesicourethrostomy" in 13 Lapoaroscopy Radcal
Prostatectomies and 2 Laparoscopy Radical
Cystoprostatectomyectomies, it make
the Vesicourethrostomy simple, easy, quick and safe.
35. Diabetic Erectile Dysfunction: Animal Studies
Yu-tian DAI1, Yun CHEN1, Run WANG2, Zeyu SUN1, Rong YANG1,
Leshen YAO1, Dong CHEN1, Sanxiang LI1
1 Department of Urology, Affiliated Drum Tower Hospital, Nanjing
University，School of Medicine, Nanjing, Jiangsu 210008, China
2 Department of Urology, University of Texas Health Science Center at
Houston and MD Anderson Cancer Center, Houston 77030, USA
Diabetes mellitus (DM) and its complications are major
causes of morbidity and mortality in the developed
countries. Erectile dysfunction (ED) is one of the most
common complications in diabetic men. Sometimes,
ED can even be the first sign of DM. The pathogenesis
of diabetic erectile dysfunction is very complex,
involved in nerve, neurotransmitter, blood vessel,
endothelial function, metabolism, endocrine and so on.
The neural factor plays a crucial role. Without influence
of vascular pathological changes, there was found
diffuse neuropathic changes in penis and pelvic ganglia
in the BB/WOR rat model. We did some work on the
neural factors. We found that the proteins of NGF,
BDNF, NT-3 and NT-4 were all detected in the
cavernous tissue. We found that NGF, NT-3, NT-4
proteins expression in cavernous tissue of diabetic ED
rats were all up-regulated compared to normal control
rats while BDNF was down-regulated. The exogenous
administration of NGF or using AdV vector mediated
NGF or using HSV vector mediated NT-3 can partly
revise the erectile function of diabetic ED rats.
The neurotransmitter factor is a very important role. As
we all known, the relaxation of the corpus cavernosum
was mediated by the L-Arg-NO-cGMP pathway. In
diabetic ED rats, we could find the decreased level and
activity of penile nitric oxide synthase (NOS) and
increased expression of arginase II. Arginase is the
enzyme that may downregulate NO production by
competing with NOS for L-Arg. Gene transfer of
endothelial NOS (eNOS) recombinant adenovirus or
calcitonin gene related peptide （CGRP） recombinant
adeno-associated virus or vasoactive intestinal
polypeptide (VIP) cDNA could enhance the erectile
response in diabetic rats.
Macroangiopathy caused the defect of hemoperfusion to
penis, and microangiopathy caused the ultrastructural
changes of penis in diabetic animals. Blood vessel
endothelium function is another factor. The impaired
endothelium caused the increased level of endothelin-1
(ET-1) and endothelin receptor B (ETRB), and the
cavernous smooth muscle contracted. The penile
expression of vascular endothelial growth factor
(VEGF) and its receptors were decreased. The
exogenous of VEGF could improve the erectile response
in diabetic rats. We found the increased level of
angiotensin-I and the decreased level of angiotensin
subtype 1 receptor in the diabetic ED rats. Valsartan, the
effective antagonist of AT1R, can reverse the erectile
dysfunction of DM rats.
Metabolism factor contains the evaluated advanced
glycation end-products (AGEs) and superoxide anion. The
treatment with the Chinese drug “Jiang Tang Qi Wei He
Ji”or extracellular superoxide dismutase gene therapy can
partly reverse the erectile dysfunction of DM rats.
The upregulated RhoA/Rho-kinase pathway in diabetic rats
mediated ED through decreased production of NO in the
penis. The inhibition of RhoA/Rho-kinase improves eNOS
protein content and activity thus restoring erectile function
in diabetes. The ion channel and cell gap junction also have
some effect on DM ED.
Though the multiple factors may play some roles on
pathogenesis of DMED, we should use combined therapy
according to the multifactorial pathogenesis of diabetic ED,
in order to elevate the therapeutic effect on DMED.
The most important treatment is to regulate the blood
glucose level to normal. In the same time, we should protect
the pelvic splanchnic nerves, vessel endothelium function,
L-Arg-NO-cGMP pathway, oxidative stress-antioxidative
system, androgen supplement, cleaning of AGEs, and so on.
We believed that gene therapy could bring us a surprise in
the future.
