Læknablaðið : fylgirit - 01.06.2009, Blaðsíða 22

27TH CONGR SCAND ASSOC UROL
F Y L G I R I T 6 1
tumours and compared with previously published results from
advanced tumours and normal bladder mucosa.
Materials and methods: Immunostaining of T1 UCC from 85
patients was done with an N-terminal (B9) and a C-terminal
antibody (C15) against FGFR3. Scoring was done in membrane
and cytoplasm (B9), or cytoplasm and nucleus (C15). No nuclear
staining was seen for B9.
Results and discussion: The predominant (74%) staining
profile for B9 was neg/+++ (mem/cyt). C15 separated the
Tl-tumours in 3 subgroups: 19% stained "normal": neg/+++
(cyt/nuc) (like 93% of normal urothelium samples). 52% of the
T1 tumours had a "malignant" profile: +++/+++ (cyt/nuc) (like
76% of metastasised UCC). The difference was significant when
normal, Tl, and advanced tumours were analysed together
(Kruskal-Wallis), and also in each of the pairwise comparisons
(Mann-Whitney). Mean survival differed by 18 months from the
"normal" group to the "malignant" group (71 vs. 53), although
not significant.
Conclusion: C15 staining is consistent with a function as a
prognostic factor. We hypothesise 1) the receptor is cleaved in
the cytoplasm, 2) the C-terminal part translocates to the nucleus,
3) this process is beneficial for the carcinogenesis, leading
to reduced survival for the patients. If mutations in FGFR3
interfere with this process, this can explain why mutFGFR3 is
overexpressed in low-grade tumours.
39 Organ-sparing treatment of upper urinary tract
transitional cell carcinoma (UUTTCC)
M Brehmer, C Malm
Depnrtment of Urology, Karolinska University Hospital and Södersjukhuset,
Siveden
camillamalm@yahoo.com
Introduction: The aim was to investigate the outcome of organ-
sparing treatment of UUTTCC
Methods In a prospective study, April 2005 October 2008, 16
patients with UUTTCC underwent organ-sparing treatment.
Indications were solitary kidney, bilateral tumour, renal
impairment, high co-morbidity or patient's refusal to undergo
nephroureterectomy. Ureteroscopically, tumour biopsy and
cytology were taken followed by laser ablation of the tumour.
Patients were followed ureteroscopically every 3 months 4
times and then at extended intervals if no recurrence occurred.
Additional treatment with BCG or mitomycin was considered
if high-grade cancer or broad based tumor or if recurrence
occurred.
Results: Mean follow-up time was 18.5 months (median
17.5). Mean age was 72.4 years (range 41-89). 6 patients had
solitary kidney, 5 because of contra lateral UUTTCC, 1 patient
had impaired renal function, 1 had bilateral tumour, 8 had
co-morbidity precluding nephroureterectomy and 2 patients
insisted on organ-sparing treatment. 12 patients had previous
history of bladder cancer. In 2 patients the tumour was located
in the renal pelvis, whereas in 14 patients the tumour was
located in the ureter. Tumour size was <15 mm in 8 patients and
>15 mm in 8 patients. Cytology was benign in 5 cases, G1 in 5,
G2 in 2, G3 in 1, atypical in 2 and missing in 1 patient. Tumor
biopsy revealed G1 in 7 cases, G2 in 1, G3 in 3 and was atypical
or undeterminable in 4. Four patients received additional BCG.
Recurrence occurred in two patients with G2 tumours > 15 mm,
after six and eighteen months respectively. Both were retreated
ureteroscopically and one the patients also received additional
Mitomycin because of high-grade cancer. After 2 instillations
he had an inflammatory reaction in the ureter and developed a
stricture that has been handled endoscopically.
No other patients have had any severe complications.
Conclusion: Laser treatment of UUTTCC in selected cases is
a safe and promising treatment. However, regular, long time
endoscopic follow-up is necessary.
40 Enterocystoplasty in patients with detrusor over
activity - long term follow up
OJ Nilsen, Aa Andersen, CM Solend, A Schultz
Oslo University Hospital, Rikshospitalet, Department of Urology, Norway
ojnil@broadpark.no
Aim of investigation: Enterocystoplasty is an established
treatment of idiopathic detrusor over activity (IDO) and
neurogenic detrusor over activity (NDO) when conservative
treatment has failed. The aim is to reduce detrusor contractility
and increase bladder capacity. This study is an objective
and subjective evaluation of the long term results after
enterocystoplasty in patients with IDO and NDO.
Material and methods: Patients with IDO or NDO, operated
with ileocystoplasty between 1990 and 2005 (72 in all) were
identified. Six patients were not alive, and 7 (9.7 %) had received
an ileal conduit. 59 patients were scheduled for follow up with
cystometry, cystoscopy and interview. Six patients did not show
up. Mean time of follow up in the included 53 patients was 7.1
years (range 2.3 - 17.9).
Results and discussion: There was no mortality. Two patients
had a pulmonary embolism, one patient had sepsis, and one
patient had a wound dehiscence. Mean Maximal Cystometric
Capacity increased from 307 ml (± 138) preoperatively to 507 ml
(± 112) at follow up (p<0.001). Mean Maximal Detrusor Pressure
decreased from 54 cmH,0 (± 37) to 14 cmH,0 (± 13) at follow up
(p<0.001). Cystoscopy showed no malignancy or stones.
The questionnaire regarding satisfaction was answered by 52
patients. 29 patients were very satisfied, 18 were satisfied, 3 were
dissatisfied and 2 were very dissatisfied. Overall 47 patients (90
%) report to be very satisfied or satisfied with the results.
Conclusions: Enterocystoplasty is efficient in increasing bladder
capacity and reducing detrusor contractility in patients with
IDO or NDO. There are few major complications, and the
patient satisfaction with the result is good.
22 LÆKNAblaðið 2009/95