1000 SURGICAL MARGINS AFTER LAPAROSCOPIC PARTIAL NEPHRECTOMY: SINGLE SURGEON EXPERIENCE
1
mean operative times, vena cava clamp times, estimated blood loss, transfusion rates, and hospital stay comparable to higher volume tertiary centers. Source of Funding: None 1000 SURGICAL MARGINS AFTER LAPAROSCOPIC PARTIAL NEPHRECTOMY: SINGLE SURGEON EXPERIENCE Francesco Porpiglia*, Cristian FIori, Riccardo Bertolo, Enrico Bollito, Mauro Papotti, Roberto Mario Scarpa, Orbassano (Torino), Italy INTRODUCTION AND OBJECTIVES: The purpose of this study is to explore the pathological outcomes of laparoscopic partial nephrectomy (LPN) for kidney tumour performed by a single surgeon in a single Institution. METHODS: We retrospectively reviewed our prospectively maintained LPN data base and we have reviewed the pathological specimen of kidney tumour treated with LPN at our Institution by a single surgeon (FP) from January 2001 to September 2009. A single uro-pathologist (EB) performed pathological analyses. The masses were divided into three Groups with a chronologic criterion: cases from 1 to 45 were assigned to Group A, from 46 to 90 were assigned to Group B whilst the remainder 44 cases (from 91 to 134) were assigned to group C. The three groups were compared according the following variables: lesion size at Computed Tomography scans (CT-scan size), pathological size and weight, staging according to TNM, minimum and maximum resection margins, differential between minimum and maxi- mum resection margin, mean of excised margin and percentage of positive surgical margins (PSM). A p-value 0.05 was considered statistically significant. RESULTS: Groups were similar in terms of CT-scan and patho- logical size (p0.05); we registered an increase in the pathological weight of the lesions in Group C respect to Groups A and B (p0.002). Of the 134 lesions, 89 were defined malignant at the pathological analysis: the 57.7% (26/45), 64.8% (31/45) and 75% (33/44), in Groups A, B and C, respectively. The distribution of malignant lesions stratified according to pathological TNM staging was: 59/89 (66%) pT1a, 25/89 (28%) pT1b, 2/89 (2%) pT2, 4/89 (4%) pT3a; we did not found statis- tically significant difference in the distribution of TNM staging inside the Groups (p0.05). Respect to Groups A and B, similar for each variable, we found differences among these Groups and Group C in terms of minimum (p 0.001) and maximum resection margin (p 0.012) and in the mean rim of healthy renal tissue removed during partial nephrec- tomy. (p 0.04). Only the differential measurement between minimum and maximum resection margin remained unchanged along the whole case study (p0.05). There was no statistically significant difference in the percentage of PSM among the Groups, with an overall rate of 2.2% (3/134); in particular no PSM were recorded in Group C. CONCLUSIONS: Our data suggest as, with the increase of surgeon experience, the amount of healthy tissue removed during LPN decreases and this could be reduce kidney damage. Moreover the reduction of this peri-tumoral tissue does not impair the oncological effectiveness of the procedure. Source of Funding: None Urodynamics/Incontinence/Female Urology: Neurogenic Voiding Dysfunction Moderated Poster 33 Monday, May 31, 2010 1:00 PM-3:00 PM 1001 DIMINISHED DETRUSOR MUSCLE CONTRACTILITY UNDERLIES THE URINARY BLADDER DYSFUNCTION INDUCED BY EXPERIMENTAL COLITIS: MECHANISM FOR PELVIC ORGAN CROSS-TALK Tirsit Asfaw*, Philadelphia, PA; Joseph Hypolite, Glenolden, PA; Gina Northington, Lily Arya, Philadelphia, PA; Alan Wein, Anna Malykhina, Glenolden, PA INTRODUCTION AND OBJECTIVES: Chronic pelvic pain is a common symptom of many gynecologic, urological and gastrointestinal conditions. Previous studies have demonstrated viscerovisceral cross- sensitization among pelvic organs via hyperexcitability of sensory and spinal neurons and the role of TRPV1 signaling in the development of neurogenic inflammation in the pelvis. The objective of this study was to elucidate the effects of desensitization of TRPV1 receptors in the colon on in vivo and in vitro contractility of the urinary bladder smooth muscle after experimentally induced colitis. METHODS: Four groups of animals (males, Sprague-Dawley rats) were included in the study: 1- control group (intracolonic saline), 2 - trinitrobenzene sulfonic acid (TNBS) induced colitis, 3 - intracolonic resiniferatoxin (RTX) instillation and 4 - intracolonic RTX followed by TNBS. The contractility of detrusor muscle was studied in vivo using awake animal cystometry and in vitro by measuring the contractile response of isolated muscle strips in organ bath setting. Cystometry was performed at baseline and 3 days post treatment while organ bath experiments were performed 3 days post treatment in all groups. The organ bath studies were performed on colonic (positive control) and bladder strips using electric field stimulation (EFS), potassium chloride test (KCL) and carbachol dose response stimulation. Maximum value (MV, g/mg) and maximum slope (MS, g/s) of the contractile response were compared among the groups. RESULTS: Acute colonic inflammation significantly decreased the response of the bladder smooth muscle to EFS (32 Hz) by almost 2-fold compared to control group (n7, p0.05). In parallel, the velocity of the response was slowed down by experimental colitis from 1.10.5 g/s to 2.20.6 g/s (n7, p0.05). These changes were accompanied by a decrease of MV in the distal colon directly affected by inflamma- tion. Desensitization of colonic TRPV1 receptors did not have signifi- cant impact on the contractility of the detrusor muscle. Responses to EFS, KCl and carbachol were also significantly lower in RTXTNBS group compared to the control. The results of cystometry on awake and freely moving animals showed marked difference in the bladder volume and pressure at micturition in animals with acute experimental colitis. CONCLUSIONS: Our results provide evidence that acute in- flammation in the distal colon modifies the function of the urinary bladder via changes in detrusor muscle contractility. Source of Funding: This work was supported by NIH/NIDDK grants DK077699, DK077699-S1(Fellowship) and DK077699- S2 (ARRA) 1002 ACUTE INFLAMMATION IN THE PELVIS MODULATES THE EXCITABILITY OF BLADDER EXTRINSIC SENSORY NEURONS VIA ACTIVATION OF VOLTAGE GATED SODIUM CHANNELS AND NON-SELECTIVE CATION CHANNELS Qi Lei*, Xiao-Qing Pan, Alan Wein, Anna Malykhina, Glenolden, PA INTRODUCTION AND OBJECTIVES: Chronic pelvic pain is a symptom of many functional pelvic disorders and develops as a result Vol. 183, No. 4, Supplement, Monday, May 31, 2010 THE JOURNAL OF UROLOGY e389
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Transcript of 1000 SURGICAL MARGINS AFTER LAPAROSCOPIC PARTIAL NEPHRECTOMY: SINGLE SURGEON EXPERIENCE
mean operative times, vena cava clamp times, estimated blood loss,transfusion rates, and hospital stay comparable to higher volumetertiary centers.
Source of Funding: None
1000SURGICAL MARGINS AFTER LAPAROSCOPIC PARTIALNEPHRECTOMY: SINGLE SURGEON EXPERIENCE
Francesco Porpiglia*, Cristian FIori, Riccardo Bertolo, Enrico Bollito,Mauro Papotti, Roberto Mario Scarpa, Orbassano (Torino), Italy
INTRODUCTION AND OBJECTIVES: The purpose of thisstudy is to explore the pathological outcomes of laparoscopic partialnephrectomy (LPN) for kidney tumour performed by a single surgeon ina single Institution.
METHODS: We retrospectively reviewed our prospectivelymaintained LPN data base and we have reviewed the pathologicalspecimen of kidney tumour treated with LPN at our Institution by asingle surgeon (FP) from January 2001 to September 2009. A singleuro-pathologist (EB) performed pathological analyses. The masseswere divided into three Groups with a chronologic criterion: cases from1 to 45 were assigned to Group A, from 46 to 90 were assigned toGroup B whilst the remainder 44 cases (from 91 to 134) were assignedto group C. The three groups were compared according the followingvariables: lesion size at Computed Tomography scans (CT-scan size),pathological size and weight, staging according to TNM, minimum andmaximum resection margins, differential between minimum and maxi-mum resection margin, mean of excised margin and percentage ofpositive surgical margins (PSM). A p-value � 0.05 was consideredstatistically significant.
RESULTS: Groups were similar in terms of CT-scan and patho-logical size (p�0.05); we registered an increase in the pathologicalweight of the lesions in Group C respect to Groups A and B (p�0.002).Of the 134 lesions, 89 were defined malignant at the pathologicalanalysis: the 57.7% (26/45), 64.8% (31/45) and 75% (33/44), in GroupsA, B and C, respectively. The distribution of malignant lesions stratifiedaccording to pathological TNM staging was: 59/89 (66%) pT1a, 25/89(28%) pT1b, 2/89 (2%) pT2, 4/89 (4%) pT3a; we did not found statis-tically significant difference in the distribution of TNM staging inside theGroups (p�0.05). Respect to Groups A and B, similar for each variable,we found differences among these Groups and Group C in terms ofminimum (p � 0.001) and maximum resection margin (p � 0.012) andin the mean rim of healthy renal tissue removed during partial nephrec-tomy. (p � 0.04). Only the differential measurement between minimumand maximum resection margin remained unchanged along the wholecase study (p�0.05). There was no statistically significant difference inthe percentage of PSM among the Groups, with an overall rate of 2.2%(3/134); in particular no PSM were recorded in Group C.
CONCLUSIONS: Our data suggest as, with the increase ofsurgeon experience, the amount of healthy tissue removed during LPNdecreases and this could be reduce kidney damage. Moreover thereduction of this peri-tumoral tissue does not impair the oncologicaleffectiveness of the procedure.
Source of Funding: None
Urodynamics/Incontinence/Female Urology:Neurogenic Voiding Dysfunction
Moderated Poster 33
Monday, May 31, 2010 1:00 PM-3:00 PM
1001DIMINISHED DETRUSOR MUSCLE CONTRACTILITY UNDERLIESTHE URINARY BLADDER DYSFUNCTION INDUCED BYEXPERIMENTAL COLITIS: MECHANISM FOR PELVIC ORGANCROSS-TALK
Tirsit Asfaw*, Philadelphia, PA; Joseph Hypolite, Glenolden, PA;Gina Northington, Lily Arya, Philadelphia, PA; Alan Wein, AnnaMalykhina, Glenolden, PA
INTRODUCTION AND OBJECTIVES: Chronic pelvic pain is acommon symptom of many gynecologic, urological and gastrointestinalconditions. Previous studies have demonstrated viscerovisceral cross-sensitization among pelvic organs via hyperexcitability of sensory andspinal neurons and the role of TRPV1 signaling in the development ofneurogenic inflammation in the pelvis. The objective of this study wasto elucidate the effects of desensitization of TRPV1 receptors in thecolon on in vivo and in vitro contractility of the urinary bladder smoothmuscle after experimentally induced colitis.
METHODS: Four groups of animals (males, Sprague-Dawleyrats) were included in the study: 1- control group (intracolonic saline), 2- trinitrobenzene sulfonic acid (TNBS) induced colitis, 3 - intracolonicresiniferatoxin (RTX) instillation and 4 - intracolonic RTX followed byTNBS. The contractility of detrusor muscle was studied in vivo usingawake animal cystometry and in vitro by measuring the contractileresponse of isolated muscle strips in organ bath setting. Cystometrywas performed at baseline and 3 days post treatment while organ bathexperiments were performed 3 days post treatment in all groups. Theorgan bath studies were performed on colonic (positive control) andbladder strips using electric field stimulation (EFS), potassium chloridetest (KCL) and carbachol dose response stimulation. Maximum value(MV, g/mg) and maximum slope (MS, g/s) of the contractile responsewere compared among the groups.
RESULTS: Acute colonic inflammation significantly decreasedthe response of the bladder smooth muscle to EFS (32 Hz) by almost2-fold compared to control group (n�7, p�0.05). In parallel, the velocityof the response was slowed down by experimental colitis from 1.1�0.5g/s to 2.2�0.6 g/s (n�7, p�0.05). These changes were accompaniedby a decrease of MV in the distal colon directly affected by inflamma-tion. Desensitization of colonic TRPV1 receptors did not have signifi-cant impact on the contractility of the detrusor muscle. Responses toEFS, KCl and carbachol were also significantly lower in RTX�TNBSgroup compared to the control. The results of cystometry on awake andfreely moving animals showed marked difference in the bladder volumeand pressure at micturition in animals with acute experimental colitis.
CONCLUSIONS: Our results provide evidence that acute in-flammation in the distal colon modifies the function of the urinarybladder via changes in detrusor muscle contractility.
Source of Funding: This work was supported by NIH/NIDDKgrants DK077699, DK077699-S1(Fellowship) and DK077699-S2 (ARRA)
1002ACUTE INFLAMMATION IN THE PELVIS MODULATES THEEXCITABILITY OF BLADDER EXTRINSIC SENSORY NEURONSVIA ACTIVATION OF VOLTAGE GATED SODIUM CHANNELSAND NON-SELECTIVE CATION CHANNELS
Qi Lei*, Xiao-Qing Pan, Alan Wein, Anna Malykhina, Glenolden, PA
INTRODUCTION AND OBJECTIVES: Chronic pelvic pain is asymptom of many functional pelvic disorders and develops as a result
Vol. 183, No. 4, Supplement, Monday, May 31, 2010 THE JOURNAL OF UROLOGY� e389
