Abstract for POSTER presentation

We report a case of a simple ureterocele, containing multiple calculi within, prolapsing through the urethra and presenting as vulval mass in a female aged 35 years with urinary retention. Following confirmation of diagnosis by plain x-ray and sonography, the calculi were extracted by incising the ureterocele, ureterocele was reduced into the bladder and later resected transurethrally. Introduction: Ureterocele is common in children and are usually associated with the upper moiety of duplex system. Those associated with a single renal system are less common, and are usually found in adults. Intravesical simple ureterocele rarely prolapse through external urethral meatus. The purpose of our presentation is to emphasize upon prolapsed ureterocele as a differential diagnosis for vulval mass with urinary retention and its management. Case report: A 35-year old female, presented to our emergency department with vulval mass with urinary retention. Local examination revealed a plum-coloured interlabial mass emerging from meatus which was firm in consistency and was irreducible. Suprapubic bulge was found on abdominal examination. X-ray and sonography revealed prolapsed left simple uretreocele with multiple calculi with left hydroureteronephrosis. Calculi were extracted after incising the ureterocele and


Materials and methods:
The patient was an 89 year old gentleman who suffered from chronic retention of urine and failed trial without catheter. Surgery was indicated for recurrent catheter related complications, and the aim was to make the patient catheter-free. The total prostate size was 101ml on transrectal ultrasound. Transurethral enucleation of the prostate was performed by the second author under spinal anaesthesia. A 24 Fr irrigating cystoscope with normal saline and 120W Greenlight High Performance System was used. Cystoscopy showed trilobar enlargement of prostate. The operation was started by incising the prostate just proximal to veru montanum circumferentially down to the capsule with 80W settings. The plane between the adenoma and prostate capsule was developed by the tip of the scope. Capsular vessels were controlled at the same time with laser. The proximal end of the adenoma was detached from the bladder neck by laser incision. The adenoma specimen was then retrieved en-bloc via a suprapubic cystostomy wound. A vertical 3cm miniincision was made at the lower abdomen. The adenoma was retrieved with sponge forceps via an anterior cystotomy. The bladder was closed in double layers. A 24 Fr 3-way urethral catheter was inserted to the bladder without need of traction. Total laser energy was 42110J and laser time was 11 min. Total operative time was 120 minutes. The prostate adenoma retrieved weighed 75g.
Results: Post-operative haemoglobin decreased by 0.7g/ dL. Bladder irrigation was continued for 12 hours after operation. No further bladder washout or irrigation was required. CT cystogram on post-operative day 7 showed no contrast extravasation and foley catheter was removed. He could void well and residual urine was only 50ml. Uroflowmetery was performed at post-operative 6 weeks: Vcomp 130ml, Qmax 13.1ml/s, Post void bladder scan 15ml.
Conclusion: PVP enucleation is feasible as an alternative to HoLEP and TURis enucleation for very large prostates. Compared with transurethral morcellation of adenoma, a mini cystostomy incision for adenoma retrieval is safe, time-saving, less expensive, and readily available. Purpose: Overactive bladder (OAB) is a symptom syndrome characterized by urgency, frequency with or without urge incontinence. Antimuscarinic drugs are the first line treatment for patients with OAB, but some patients may have poor response to oral medication. Extracorporeal electromagnetic stimulation of the pelvic floor had been used for the treatment of stress and urge urinary incontinence. We report our preliminary results of extracoporeal electromagnetic stimulation for patients with OAB.

Materials and methods:
Between June 2009 and March 2010, 27 patients (14women and 13 men) with frequencyvolume chart confirmed OAB were enrolled in the study. All patients had used antimuscarinic medication, but not satisfied about the treatment results. The NeoControl chair (NeoTonus, Marietta, GA, USA) was then used in combination with oral medication, and treatment consisted of 2 sessions per week for 9 weeks. OAB symptom score (OABSS) questionnaire was recorded before and after Materials and methods: Testis materials were obtained from 20 azoospermic male patients who underwent testicular sperm extraction (TESE) as a part of infertility treatment. The obtained tissues were mechanically and enzymatically dissociated and cultured for 4 days in knockout culture medium with glia-derived neurotropic factor (GDNF) and leukaemia inhibitory factor (LIF).
Attached cells were retrieved and CD49f positive cells were selected using magnetic activated cell sorting (MACS) system. For further enrichment of SSC we used subsequent matrix selection with collagen and laminin, and obtained pure population of SSC were cultured with the same medium described above. To characterize cultured cells, reversetranscriptase polymerase chain reaction (RT-PCR) and immunofluorescence were used.

Results:
In immunocytochemistry, SSC obtained from obstructive azoospermia patients were positive for VASA and DAZL, which are germ cell markers, and also OCT3/4, a stem cell marker. They were negative for NANOG and E-cadhelin, which are embryonic stem (ES) cell markers. Most cases usually visit hospitals at the initial time due to painful symptoms and deformity of penis. We reported a case of penile fracture presented as penile abscess with delayed developed symptoms.

Materials and methods:
A 32 year-old male patients visited our clinic for swelling and tender symptoms of penis. According his statement, a click sound was noted at sexual behavior 2 weeks ago. There is no obvious penile deformity except mild tender lesion at initial. The patient kept the ability of erection and sexual intercourse at the first week. Ventral tender lesion of penis developed progressively at the second week and forced him to visit our clinic. Penile abscess was impressed by ultrasound image finding and leukocytosis. The abscess was drained by operative exposure and penile fracture was confirmed by tear lesion in the tunica albuginea. The defect of tunica albuginea was repaired and antibiotic therapy was giving.

Results:
The patient s wound healed slowly due to local edematous change. The patient s erectile potency recovered after surgical treatment and returned to normal sexual activities 1 month later.

Conclusion:
Penile abscess formation is a rare complication of penile fracture due to delayed repair. Unapparent symptoms induced this patient miss the initial treatment.
Purpose: It is commonly believed that coarser suture materials should be used to provide sufficient tenacity in tunical surgery for penile curvature correction and/ or penile morphology reconstruction. We report our 15-year experience of fine sutures in a second operation in 33 patients who underwent prior curvature correction elsewhere with coarser sutures, resulting in resumption of penile curvature associated with erectile dysfunction.

Materials and methods:
From February 1993 to November 2009, unsatisfactory postoperative outcomes prompted 41 patients, aged 19 to 37 (mean age=29), to consult our institute after previous tunical surgery at other institutions. These patients were remarkable for normal erectile function prior to the first tunical surgery in which 2/3-0 nylon sutures were used. They frequently presented with recurrence of penile curvature resulting from herniation/weakening of a tunical region or even crateriform tunical defects associated with gradual loss of erectile capability and palpable lumps. In this series, 33 patients underwent a revised Nesbit procedure at the level of the collagen bundles using finer sutures which is optimal for approximation of collagen bundle. Prior to July 1998, 10 men underwent salvage surgery using 4-0 polyglactin sutures. Thereafter, we have adapted 6-0 nylon sutures for another 23 patients. These were categorized into the polyglactin and nylon groups respectively. Overall, 31 patients were available for a follow-up while using the abridged five-item version of the International Index of Erectile Function (IIEF-5) scoring system with 22 patients in the nylon group. We have found cavernosography a practical and reliable method to objectively assess penile morphology in these patients.

Results:
The follow period ranged 0.6 to 16.0 years with an average of 6.9±2.5 years. The penile morphology both subjectively and objectively was excellent in all patients, except for one in each group. Erectile function restoration showed a trend of satisfaction in the polyglactin group and based on IIEF-5 was significantly improved in the nylon group (14. 2±3.5 vs. 21.8±2.2, n=22, p<0.001).

Conclusion:
We may suggest that in penile tunical surgery, fine sutures such as 6-0 nylon may be an ideal suture material for resulting better penile morphology and functional outcomes since it has been sustainable in salvaging tunical surgery.

PP28-25
The evaluation of Y chromosome microdeletion in males with severe oligospermia or azospermia Rahim Taghavi 1 , Reza Mahdavi 1 , Mohammad Reza Darabi Mahboub 1 1 Department of Urology, Imam Reza Hospital (Iran) Purpose: 50%of infertilities arise from male factors of which genetic defects are important ones. Microdeletion of the long arm of Y chromosome has been seen in about7% of infertile men and with specific patient selection this incidence is higher.

Materials and methods:
Forty seven azoospermic or severe oligospermic patients were examined with serum hormone measurement especially FSH ,karyotype, Y chromosome microdeletion testing using 11 pairs of sequence-tagged site sets specific for AZFand SRY loci and accasionally testicular biopsy were done.
Results: Four patients had Y chromosome microdeletion. 3patients were azoospermic. Klinefelter's syndrome and deletion of SRY region were seen in2 patients 4.3%and 4.3%, respectively. All of these 4 patients were azoospermic. Multiple AZF region deletion was seen in 75% of Ychromosome microdeletion, AZFc region in 4 of 4 patients. Deletions in AZFb and AZFa regions were found in 3(75%) and 1(25%) patients respectively. AZF deletion incidence in patients with FSH level abnormality and without it were 17.6% and 3.3% respectively, however, the difference was not significant (P=0.125).Also there wasn't any significant difference in AZF deletion incidence between Azoospermic and sever oligoospermic patients (11.1%and 3% respectively; P=0.628) and between varicocele involved patients and others (P=1.000). Family history had no significant effect on AZF deletion incidence (P=0.239). Testicular biopsy had been done in 3 of 4 patients with AZF microdeletions and all biopsies showed SCOS.
Conclusion: There is a high incidence of Y chromosome microdeletion in male factor infertility, There is a probability of transmission of Y chromosome microdeletion to children, so the diagnosis of that in severe oligoospermia and nonobstructive azoospermia is necessary but it needs more investigations.

PP28-26
Raised PSA and prostate cancer detection in Malaysia Materials and methods: (case report)A 39-year-old man was incidentally found to have an elevated serum CEA level, 20.2 and Intermittent painless gross hematuria for 2 months. Frequency with lower abdominal discomfort during the recent 2 months was also noted. During the whole course, there was no body weight loss or change of bowel habit. General physical examinations, hematological and biochemical study results were within normal limits.
Urinalysis revealed numerous red blood cells per high power field. Further image study was performed.
Results: A computer tomographic (CT) scan of the abdomen and pelvic cavity demonstrated a well marginal enhanced solid mass lesion at submucosal lesion of bladder dome, extended from umbilicus to bladder dome. Cystoscopy showed a nonpapillary ulcerative tumor at the dome of the bladder. Urachal adenocarcinoma with bladder dome invasion was our impression. En bloc resection of the tumor, including the umbilicus, urachus, peritoneum and bladder dome was performed. The pathology results indicated Mucin-produced urachal adenocarcinoma, enteric type with bladder dome invasion.
Conclusion: En bloc resection of the urachal tumor and urachus coupled with extended partial cystectomy cures 70% of patients with clinically localized urachal carcinoma. Grade and Tumor stage has been identified as an important predictor of outcome for urachal adenocarcinoma. Margin status was also important because virtually all survivors had negative surgical margins. After tumor resection for 3 months, the CEA level had declined to 1.59. In this cases, CEA is a useful tumor marker for monitoring tumor recurrence.

PP28-28
Laparoscopic partial nephrectomy for hilar tumorstwo cases report and review of literature Wen-Ching Han 1 , Yu-Chi Chen 1 , Victor C. Lin 1 1 Division of Urology, Department of Surgery, E-Da Hospital (Taiwan) Laparoscopic partial nephrectomy was first reported by Winfield et al in 1992 and is current considered a reasonable treatment option for small renal tumor. Laparoscopic partial nephrectomy is a technical challenging procedure due to difficulty in adequate tumor resection and minimizing warm ischemia time of the kidney. It was especially difficult when excised the hilar located renal tumor due to the need to avoid injury of the hilar vessels. Herein we reported two cases with renal hilar angiomyolipoma received laparoscopic partial nephrectomy and review of literatures.
Introduction: Mucinous cystic neoplasms (MCNs) encompass a spectrum ranging from benign but potentially malignant to carcinoma with aggressive behavior. MCNs are commonly seen in perimenopausal women, and about two-thirds are located in the body or tail of the pancreas. Like cystadenomas, most MCNs are now incidental findings identified during imaging performed for other reasons. We report a case of mucinous cystadenoma discovered in a kidney mimicking a simple renal parenchymal cyst.
Case Report: A 35-year-old woman was admitted because of left flank pain and because a large cystic lesion was found in the left flank on image studies. This patient was in her usual states of health until several months before admission, when she started to feel intermittent low back pain. She went to the nephrology department and lumbago was suspected and analgesics were given. She had gastralgia two weeks later and panendoscropy, along with serum H. pylori exam, showed multiple erosions in the antrum, two shallow ulcers in the lesser curvature of stomach and H. pylori infection. Abdominal ultrasonography showed a hypoechoic, well encapsulated, 8.2cm by 6.0 cm cystic mass adjacent to the left kidney. Computed tomographic (CT) scan of the abdomen showed a nonenhancing large cystic mass with density of water, imperceptible wall, 5cm by 8cm by 8.5cm, in the left posterior pararenal space. The medial aspect of the lesion was seen closely abutting the lateral lower border of left kidney and a 1.1cm by 0.8cm high density nodule in the superior aspect of the cystic lesion was seen, probably due to high proteinous content or mural part. She was transferred to the urology department and reported no fever, chills, nausea, vomiting, abdominal fullness, diarrhea or constipation. The physical examination revealed left costovertebral angle knocking tenderness and symptomatic renal cyst, mucinous cystadenoma or urogenital cyst (such as Mullerian cyst) was suspected. We performed a retroperitoneal exploration through a left lumbar incision below the 12th rib. We found two cystic masses and the two masses were totally resected. Pathology showed that the specimen submitted consisted of 2 pieces of cystic cystic tissue measuring up to 9.5 cm in greatest dimension and fatty tissue measuring 3 cm in greatest dimension. The smaller specimen submitted consisted of a piece of cystic tissue measuring 1 cm in greatest dimension. On section, both cystic masses contained clear fluid. No dysplasia or malignant cell was seen. Renal mucinous cystadenoma was confirmed.
Discussion: Adenocarcinomas arising from the renal pelvic epithelium are very rare, accounting for less than 1% of all epithelial malignancies found in the renal pelvis. The genesis of retroperitoneal mucinous cystadenoma is unknown. The most promising theory is that of coelomic metaplasia.
Conclusion: Mucinous cystadenoma in the retroperitoneal space is rare and mostly occurs in female patients. Urologists must be cognizant of retroperitoneal mucinous cystadenoma because it can mimic large renal cysts. Surgical removal is recommended due to the possibility of malignancy.

PP28-30
Complete response after neoadjuvant chemotherapy for locally advanced bladder urothelial carcinoma-2 case reports painless gross hematuria, and fibercystoscopy revealed papillary bladder tumor in both cases. Pathology of TURBT showed high grade invasive urothelial carcinoma. Whole abdominal CT showed no definite distant metastasis. Neoadjuvant chemotherapy with regiment of Gemzar and Cisplatin was applied.
Results: Follow-up CT showed no intraluminal tumor mass or grossly enlarged lymph nodes. Pathology of random transurethral biopsy showed no evidence of malignancy. Both cases had complete response to chemotherapy and one of them had no recurrence in 2 years follow-up.
Conclusions: Neoadjuvant chemotherapy enables organ preservation in carefully selected patients. Select patients with muscle-invasive bladder cancers may survive after transurethral resection and neoadjuvant chemotherapy. However, close follow up is suggested.

PP28-31
Annexin-I overexpression is associated with tumour progression and independently predicts inferior disease-specific and metastasis-free survival in urinary bladder urothelial carcinoma Chien-Liang Liu 1 , Chien-Feng Li 1 , Kun-Hung Shen 1 , Li-Chien Huang 1 , Hsuan-Ying Huang 1 , Yu-Hui Wang 1 , Ting-Feng Wu 1 1 ChiMei Hospital (Taiwan) Purpose: In our previous studies, comparative proteomics and immunohistochemistry (IHC) demonstrated that annexin-I (ANXA1) is up-regulated in high grade urinary bladder urothelial carcinoma (UBUC) as compared to nonhigh grade carcinomas. However, the small sample size prohibited further correlation of ANXA1 expression to tumour progression. Therefore, in the present study, 81 primary localised UBUC specimens of various grades and primary tumour (pT) status were examined for ANXA1 expression to further confirm the proteomics data and to clarify the relevance of ANXA1 expression level to the prognosis of UBUC.

Materials and methods:
IHC was implemented to investigate ANXA1 protein expression in 81 primary localised UBUC specimens. The association of ANXA1 expression with tumour progression and prognosis was analysed.
Results: Our data demonstrated that the ANXA1 expression level was strongly associated with an escalated pT status (p<0.001) and a higher histological grade (p<0.001), suggesting that ANXA1 might be related to tumour progression. Moreover, at the univariate level, ANXA1 overexpression, along with higher pT status and histological grade, significantly predicted diseasespecific survival (DSS) and metastasis-free survival (MFS). More importantly, multivariate analyses revealed that the association of ANXA1 overexpression and prognosis remained significant for both DSS and MFS.

Conclusion:
The above results reinforced the comparative proteomics results and confirmed the prognostic role of ANXA1 in UBUC.

Renal cell carcinoma and urothelial carcinoma in Chinese population with ESRD under dialysis therapy
Results: Twenty-five patients were diagnosed of penile squamous cell carcinoma, and two patients had penile squamous cell carcinoma and urethral transitional cell carcinoma. The other two patients had verrucous carcinoma. Most cases were diagnosed before the year of 2001. Redundant prepuce/phimosis, smoking and low socioeconomic status seemed to be the predisposing factors of penile carcinoma. The most common location of tumor was penile glans. One, seven, six, six and nine patients were of stage 0, I, II, III and IV disease respectively. There were six cases having metastatic disease. Partial penectomy on sixteen patients and total penectomy on ten patients were noted in our study. Two patients received en bloc tumor excision due to advanced tumor invasion. Nineteen patients suffered from clinical inguinal lymphadenopathy unilaterally or bilaterally. Five men received radical ilioinguinal LN dissection and one received modified ilioinguinal LN dissection. Pre-surgery or pre-biopsy antibiotics therapy of lymphadenopathy was prescribed in two patients but no remission was noted. Two cases received adjuvant chemotherapy (stageIII) and three had palliative chemotherapy (stageIV). One patient received palliative radiotherapy (stageIV), and one had palliative concomitant chemotherapy and radiotherapy (stageIV). The followup time was variable (from 1 to 216 months), and the mean followup was 24.75 months. The majority of patients were lost of followup and it was hard to estimate the survival time.
Conclusion: In our patients, the average age of first diagnosis was compatible to the previous studies. But the interval from symptoms to medical consultation was longer than patients from non-Asian area. Whether partial penectomy or total penectomy depended on the tumor location. There was no settled policy to manage the inguinal lymphadenopathy, including pre-surgical antibiotics treatment and lymph node dissection. Further prospective and large-scale study is needed to establish the database of penile carcinoma in Taiwan.

Results:
From May 2004 to Feb.2009, one hundred and sixteen patients with T1-T3 prostate cancer consecutively treatment with definitive RT (46 patients) or radical prostatectomy (70 patients) were included. The patients in surgical group had a younger age( 66.6±5.8 vs.72.5 ± 6.7y/o, P< 0.0001) and lower PSA( P=0.0072) than radiation group. Physical functioning, role functioning, social functioning, fatigue, pain, appetite loss in QLQ-C30, urinary, bowel symptoms, treatment-related symptoms and sexual functioning in PR25 declined in the 1st month after RRP, then showed a trend to improve over time in 3rd months. But the sexual function and urinary symptoms did not return to normal until 12th months. Emotional functioning significantly improved even better than baseline in 3rd months after RRP and remained at higher levels. Diarrhea, urinary and bowel symptoms exacerbated significantly after R/T in 3rd month and recovered gradually in the 6th months. But the diarrhea persisted even in the 12th months. Fatigue was a general problem among in different treatment groups, with the highest fatigue levels in the R/T group. Using multivariate analysis, patients in surgical group had better physical functioning, fatigue, bowel and sexual function than in radiation group. The patients in surgical group had better sexual function might due to younger patient in this group.
Conclusion: RRP and IMRT impact general global function, urinary, sexual, and bowel HRQOL early and late after treatment. The emerging understanding of prostate cancer HRQOL will allow urologists and patients to set realistic expectations regarding outcomes and facilitate individualized decision making regarding treatment.

PP28-35
Testicular carcinoid tumora case report and literature review not noted. The patient also denied fever, infection, or recent traveling. Hemogram and biochemistry all revealed normal, and tumor markers showed AFP:4.49ng/ml (<20ng/ml in nonpregnant women), Beta-HCG: 0.08 mIU/ml (<10mIU/ ml in male or nonpregnant female), and LDH: 197 U/L (normal range 131~250 U/L). Scrotal sonography revealed a heterogeneous echoic nodule size of 1.9cm in right testis with central calcification and increased vascularity. The patient received right radical orchiectomy, and pathology disclosed carcinoid tumor of right testis.

Discussion:
The carcinoid tumor of testis accounts for less than 1% of all testicular tumors. It often presented as painless mass or testis enlargement. Less than 1 to 3% may present carcinoid syndrome. Since the carcinoids are found mostly in gastrointestinal tract, especially in ileum. Somatostatin receptor scintigraphy or MIBG scintigraphy may have diagnostic value to exclude carcinoids from sites other than testis. Pre-operative ultrasound may present a solid, well-defined, hypoechoic mass. Radical orchiectomy is the main treatment for this tumor. Although the tumor rarely metastasize, post-operative follow up with history taking, physical examination, and urine 5-hydroxyindolacetic acid (5-HIAA) level every three months for one year, then yearly follow up, are suggested.

Conclusions:
The testis is truly a rare site for carcinoid tumor. Surgical intervention with radical excision remained mainstay of the treatment of choice.

Recurrent urothelial cancer in urinary bladder after radical nephroureterectomy
Jue-Hawn Yin 1 , Hao-Pin Tai 1 , Jow-Yu Sheu 1 1 Tungs' Taichung Metro Harbor Hospital (Taiwan) Purpose: To analyze the characteristics of bladder recurrent urothelial cancer after radical nephroureterectomy and to evaluate the necessity of regular cystoscopy examination of urinary bladder.

Materials and methods:
We collected 8 cases of recurrent urothelial cancer of urinary bladder after radical nephrouretectomy for upper tract transitional cell carcinoma in past 5 years. There are 5 male and 3 female, age ranged 52 to 83 years old. The follow up examination included urinalysis, cytology, IVP, sonogram and cystoscopy. The recurrence occurred at 3 to 19 months.
Results: There are one cases recurred at prostatic urethra, six cases at bladder and one case at both bladder and prostatic urethra.There are two cases with normal urinalysis for times but the cystoscopy disclosed recurrence in urinary bladder and urethra.Majority of the recurrent urothelial cancer are grade 1 and Ta transitional cell carcinoma. One case is carcinoma in situ. One case has recurrent bladder carcinoma and controlateral ureteral carcinoma need cystectomy.

Conclusion:
The regular follow up with cystoscopy is mandatory. The urinalysis and IVP cannot evaluate the bladder recurrence in detail.Majority of the recurrence in urinary bladder are Ta, grade 1 transitional carcinoma. One case is carcinoma in situ.

PP28-37
Is nephron-sparing surgery adequate for angiomyolipoma ? due to presumed malignancy in preoperative image. The overall early complication rate was 3 patients. At a median postoperative follow-up of 3 years. The median preoperative serum creatinine level was 1.0 mg/dL and last follow-up was 1.1mg/dL.

Conclusion:
Nephron-sparing surgery for sporadic renal angiomyolipomas offers preservation of renal function and is associated with acceptable complication. The results of this study support nephron-sparing surgery for these lesions.

PP28-38 Combretastatin A-4 inhibits cell growth and metastasis in bladder cancer cells and retards tumor growth in a murine orthotopic bladder tumor model
Cheng-Huang Shen 1,2,3 , Jia-Jen Shee 1,2,3 , Jin-Yi Wu 1,2,3 , Yi-Wen Lin 1,2,3 , Jiann-Der Wu 1,2,3 , Yi-Wen Liu 1,2,3 1 Department of Urology, Department of Pathology, Chiayi Christian Hospital (Taiwan) 2 Division of Urology, Department of Surgery, Chang Gung Memorial Hospital (Taiwan) 3 Graduate Institute of Biomedical and Biopharmaceutical Sciences, College of Life Sciences, National Chiayi University (Taiwan) Purpose: Bladder cancer is a high recurrent cancer after current intravesical therapy, so it is necessary to find new drugs for this therapy. Combretastatin A-4 (CA-4), an antitubulin agent, has been identified as an anti-cancer agent. In this study, we investigated the anti-cancer activity of CA-4 in human bladder cancer cells and in the murine orthotopic bladder tumor model.

Materials and methods:
Cytotoxicity of CA-4 was measured by MTT assay, PI staining assay and clonogenic survival assay. In vivo microtubule assembly assay, cell cycle analysis, Western blot and cell migration assay were used for mechanism study. Intravesical CA-4 therapy was performed in a murine orthotopic bladder tumor model.

Results
: CA-4 inhibited tubulin polymerization in vivo. Cytotoxic IC50 of CA-4 in human bladder cancer cell lines was below 4 nM. Analysis of cell-cycle distribution showed CA-4 obviously induced G2-M phase arrest with sub-G1 formation. The analysis of apoptosis showed that CA-4 induced caspase-3 activation and the decrease of BubR1 and Bub3 in BFTC 905 cells. In addition to apoptosis, we also found that CA-4 induced multinucleated cells. CA-4 had significant effect on reducing cell migration in vitro. Importantly, the in vivo study also revealed that intravesical CA-4 retarded the development of murine bladder tumor.
Conclusion: These data demonstrated that CA-4 caused bladder cancer cell death through apoptosis and mitotic catastrophe. It inhibited cell migration in vitro and tumor growth in vivo. CA-4 intravesical therapy at least provides another strategy in treating superficial bladder cancers.

PP28-39
Localized prostate cancers treated with cyberknife delivered hypofractionated radiotherapy an initial experience and outcome analysis the isodoses in order to compare plans: one way is to use the equal average tumor dose, another is to use equal maximum target dose. Follow up at least 6 months after Cyberknife treatment, PSA was dramatically reduced after CK. Advantage of CK are short treatment course, no invasive, no hospital stay or anesthesia, fewer and more transient side effects. No Need for Radiation Precautions. At this study are still some limitation such as Short followup period and data supports is only urinary or rectal toxicity. Small amount of patients and need for long-term evaluation of rectal and genitourinary toxicity are also our study limitation.

Conclusion:
CyberKnife is used to design a course of radiotherapy for localized prostate cancer. Fiducial markers within the gland are used to verify organ position and track organ motion via an orthogonal pair of electronic x-ray imaging devices and provide real-time feedback correction to the robotic arm during delivery. The CyberKnife can produce superior dose volume histograms (DVHs) for sparing of rectum and bladder and excellent DVHs for target coverage compared with IMRT, and possesses dose heterogeneities to the same degree as IMRT plans. Further follow up and evaluation will be presented at our study.

Results:
The results were summaries in table 1. Most patients were middle-aged (mean: 49.8 years old). The average tumor sizes are 4.3 cm diameters. Most cases were accidentally found the tumor growth during image studies except case 4 had the clinical presentation of soreness of left flank with painless hematuria. The surgical treatments include partial nephrectomy (case 2), nephroureterectomy (case 1, 3) and laparoscopic nephrectomy (case 4). Most of our cases the tumor was located at lower pole of kidney except case 1 located at middle pole. The image characters are showed in figure 1. The gross appearance and pathology picture of case 4 showed in figure 2. The prognosis is excellent. There have two cases (case1, 2) been follow up to 5 years and no recurrent was found in recent image studies. Two cases (case 3, 4) were just diagnosed in last year and will follow up for prognosis.
Conclusion: MCRCC is subtype of renal cell carcinoma with a low nuclear grade and stages, and excellent prognosis regardless of tumor size. Although there were good outcome for our patients, due to the limited number of patients in our study, the further research and follow up are needed to understand the prognostic characteristics about MCRCC.

PP28-41
The role of histone deacetylase inhibitor mediated G2/M cellcycle arrest in prostate cancer cells Tai-Lung Cha 1 , Guang-Huan Sun 1 , Sun-Yran Chang 1 , Dah-Shyong Yu 1 A269 (PCa) cells and elucidating the novel molecular mechanisms involved in growth arrest and apoptosis by targeting the important non-histone molecules.

Materials and methods:
We analyzed the growthinhibition effect of HDAC on RCC, prostate cancer cells by MTT assay in vitro and antitumor efficacy by xenograft experiments in vivo. To verify the associated molecular mechanisms involved in HDACi-mediated cell death and cell cycle progression by western blotting and FACS analysis.
Results: HDAC inhibitor induced Aurora depletiondependent and -independent pathways by targeting HDAC3 and HDAC6 of PCa cells. The dual degradation of Aurora A and B kinases mediated by HDACi-LBH589 resulted in inducing late G2 phase arrest and apoptosis of PC3 PCa cells; whereas LBH589 induced Aurora depletionindependent pathway to activate ERK contributed to early M phase arrest of LNCaP PCa cells. The aforementioned mechanisms involved in either late G2 or early M phase arrest are general phenomena mediated by different HDAC inhibitors. Our results also demonstrated that novel HDACi-LBH589 potently inhibited PCa cells growth in vitro and suppressed tumor formation in vivo.

Conclusion:
Our in vitro and in vivo data demonstrated that novel HDACi LBH589 has potent anticancer effect of PCa cells. HDACi treatment resulted in inducing late G2 or early M phase arrest and apoptosis of PCa cells through Aurora depletion-dependent and -independent pathways by targeting HDAC3 or HDAC6. The clinical efficacy of LBH589 in the treatment of patients with metastatic PCa, especially those with high Aurora kinase and HDACs expression, is worthy of further investigation.

Memorial Hospital (Taiwan)
Purpose: Extrapulmonary small-cell carcinoma (EPSCC) is a relatively rare disease, encompassing <5% of all SCC with an approximate incidence of <0.4% of all cancers in the United States. We retrospectively reviewed clinical characteristics and outcome of 7 patients with genitourinary small cell carcinoma (GUSCC) between 1993 to 2009 at our hospital.

Materials and methods:
All data were collected by reviewing medical records. By definition, patients with EPSCC have a normal plain radiograph or CT scan of the chest and normal sputum cytology or negative bronchoscopic findings. Only GUSCC was studied in this review.

Results:
Our study included 6 males and 1 female. The age ranged from 59 to 82 years old (mean 68 years). The most common presenting symptom in patients with GUSCC is painless gross hematuria. Some patients complained of lower urinary symptoms such as frequency, dysuria and urgency. Approximately 57% of the affected patients (66% of the male patients) had a history of smoking. The primary site of GUSCC was less frequent at kidney in our study. In this study, 5 patients (71%) had extensive disease(ED), 3 patients received platinum-based chemotherapy, the response rate of which was 33.3%. The overall survival was poor, with a median of 11 months (range, 11-16 months), and the natural history seems to resemble closely that of extensive disease of small cell lung cancer (ED SCLC) with early and rapid dissemination.
Conclusion: GUSCC was rare with aggressive biological behavior, early dissemination and frequent recurrences. Most patients are diagnosed in the advanced stage with poor prognosis in this study. The natural history seems to resemble closely that of ED SCLC with early and rapid dissemination. Clinical trials using new regimens which include topoisomerase I inhibitors or taxanes are warranted in attempts to improve the treatment outcome of ED GUSCC.

PP28-43
Prognostic significance of prostate cancer susceptibility variants on prostate-specific antigen recurrence after radical prostatectomy However, the association between these variants and biochemical failure in prostate cancer patients receiving radical prostatectomy has not been determined.

Materials and methods:
We systematically evaluated 2 0 p r o s t a t e c a n c e r -a s s o c i a t e d s i n g l e -n u c l e o t i d e polymorphisms in a cohort of 320localized prostate cancer patients receiving radical prostatectomy. Each single-nucleotide polymorphism found to be associated with the recurrence of prostate-specific antigen was further analyzed by Kaplan-Meier analysis and Cox regression model.

Results
: Three prostate cancer susceptibility singlen u c l e o t i d e p o l y m o r p h i s m s ( r s 1 4 4 7 2 9 5 a t 8 q 2 4 , rs7920517 and rs10993994 at 10q11) were associated with prostate-specific antigen recurrence (P < 0.02). Of these, rs7920517 and rs10993994, which were in strong linkage disequilibrium (r2 = 0.91), also showed significant associations with poor prostate-specific antigen-free survival following radical prostatectomy (log-rank test; P < 0.01). The associations remained significant in our multivariate Cox proportional hazards analysis after adjusting for other clinicopathologic risk covariates (P < 0.01).

Conclusion:
In conclusion, loci associated with risk for prostate cancer, such as rs7920517 and rs10993994, might also be used to predict the recurrence of prostatespecific antigen in prostate cancer patients receiving radical prostatectomy. (Cancer Epidemiol Biomarkers Prev 2009;18(11):3068-74).

PP28-44
Solitary fibrous tumor of the urinary bladder with malignant potential-a case report and literature review Shih-Hao Cheng 1 , Shian-Shiang Wang 1 , Yen-Chuan Ou 1 , Chen-Li Cheng 1 1 Division of Urology, Department of Surgery, Taichung Veterans General Hospital (Taiwan) Purpose: We present a very rare case of mesenchymal tumor with malignant potential originating from the urinary bladder and review the literature.

Materials and methods:
A 67-year-old man had noticed a palpable mass over the right lower quadrant of his abdomen for 2 years. He had suffered from abdominal pain during exercise 1 month before admission. Abdominal MRI showed a large soft tissue mass in the urinary bladder with several cystic components. Urinary analysis revealed A271 hematuria but urine cytology was negative for malignant cells. A tumor maker survey showed mildly elevated CA 125; however, AFP, CEA, PSA, CA 199, and CA153 were all within the normal ranges. A whole-body bone scan failed to show any metastatic lesions. He received an operation for tumor resection. The operative findings revealed that the tumor had arisen from the dome of the urinary bladder and had adhered to the small intestine. Partial cystectomy with removal of the tumor and segmental resection of the small intestine were carried out. The pathologist reported a solitary fibrous tumor with malignant potential, evidence of tumor necrosis, mitotic activity of >4 mitoses per 10 high-power fields, and an infiltrative margin. Immunohistochemical studies yielded positive results for CD34 and CD99, but were negative for CD117, SMA, and AE1/AE3. The postoperative recovery was smooth. The patient has been well and no tumor recurrence could be found after an 18-month follow-up.

Results:
Solitary fibrous tumors of the urinary bladder are extremely rare and there have been only nine cases reported in the English literatures. The patient described here is the second case of this type of tumor with malignant potential. The common clinical manifestations are pain and palpable mass. Hematuria, hypoglycemia, and dysuria are less common but also reported. The image of the tumor is not specific and it often appears as a well-circumscribed, highly vascular mass without invasion of nearby structures. Extrapleural solitary fibrous tumors have a higher rate of regional recurrence, suggesting a more aggressive clinical behavior. Malignancy in pathology also accounts for higher local recurrence, metastatic, and mortality rates. According to a recent study, the five-year survival rate is 40%. Tumors in the abdomen, retroperitonium, and pelvis appear to have a higher recurrence rate. The most effective treatment for the tumor is considered surgery with complete resection. However, adjuvant radiotherapy is sometimes applied for recurrent intra-thoracic or extremity lesions.

Conclusion:
Complete surgical resection is recommended for solitary fibrous tumors of the urinary bladder with malignant potential. More clinical data are needed to evaluate the outcomes of the patients with such tumors.

PP28-45
Trend of life expectancy of patients for radical prostatectomy of prostate cancer in Taiwan-2010 update Chih-Cheng Lu 1 , Tse-Chou Cheng 1 1 Chi Mei Medical Center, Liouying (Taiwan) Purpose: According to the clinical consensus of prostate cancer diagnosis and management by Taiwan Cooperation Oncology Group (TCOG), life expectancy of the patients receiving radical prostatectomy in localized prostate cancer is 10 years or more. This study is to assess and review the trend of life expectancy of male population in Taiwan for the reference in clinical practice.

Materials and methods:
From 1991 to 2007, life expectancy reports by the service of the Department of Statistics, Ministry of the Interior (MOI) of Taiwan were reviewed. The printed and online materials in practice guidelines or consensus for prostate cancer by TCOG and National Comprehensive Cancer Network (NCCN) were reviewed. Investigate the trend of life expectancy of the male population in Taiwan region which includes Taipei city, Kaohsiung city but no Fukien special areas.

Results:
Average 5-year survival rate of prostate cancer is around 70% mentioned by TCOG. When the patient s life expectancy is less than 5 years, no further workup or treatment is suggested except for some high risky patients in the latest version of NCCN. Radical prostatectomy is considered when the patients with a life expectancy of 10 years or more and no serious co-morbid conditions that would contraindicate an elective surgery by NCCN in 2010. From 1991to 2007, the male life expectancy at birth in Taiwan was from 71.8 up to 75.4 years. The report of life expectancy more than 10 years from MOI showed at the age of 71 years in 199171 years in , 72 years from 199271 years in to 199571 years in , 74 years in 199671 years in , 75 years from 199771 years in to 199971 years in , 76 years from 200171 years in to 200571 years in , and 77 years in 200671 years in . In 2007, the male life expectancy at the age of 77 and 78 years were 10.14 and 9.64 years, respectively.

Conclusions:
In this limited retrospective study, 77 years of age is the upper limit for the patients with localized prostate cancer considering to undergo radical prostatectomy in Taiwan region. Further research with longer follow-up is needed to clarify the relationship.

PP28-46
Xanthogranulomatous cystitis -a very rare benign tumor mimicking an abdominal tumor-a case report Yung-Tai Chen 1 , Jun-Kai Wang 1 , Jih-Sheng Chen 1 , Shin-Hong Chen 1 1 Department of Urology, Taiwan Adventist Hospital (Taiwan) Purpose: Xanthogranulomatous cystitis is a very rare disease with only about 20 cases reported up to now. It is a chronic benign inflammation disease of unknown etiology. We reported our experience in treating a case of such rare benign tumor mimicking an abdominal tumor. The tumor originated from superior bladder wall and extended to sigmoid colon that made the diagnosis difficult.

Materials and methods:
A 57-year-old male presented with left lower abdominal pain and mild voiding difficulty. A hard mass could be palpated while the urinary bladder was distended. The patient has past history of colon polyps. Urinalysis , routine urine culture and culture for tuberculosis didn t reveal any urinary tract infection. Intravenous urography showed a filling defect at left half urinary bladder. Cystoscopy unveiled mild polyposis at left bladder wall but no bladder tumor was noted. Abdominal computed tomography disclosed an ill delineated infiltrated heterogeneous enhanced mass lesion in pelvis with involvement of bowel loop and urinary bladder. Serum CEA level(1.45mg/dl) and PSA concentration(0.75ng/ml) were within normal limit. Colon fiberoscope showed some benign colon polyps. The sigmoid colon was constricted at the site of 40 cm above anal verge. Whether the tumor originated from urinary bladder or sigmoid colon could not be concluded from the above studies. Thus he underwent exploratory laparotomy. During operation, a 9×6×7cm hard mass was noted to come from the superior lateral urinary bladder. The sigmoid colon was adhered to the tumor. The tumor was excised together with adjacent bladder tissue and a segment of sigmoid colon.
Results: Pathology examination revealed the tumor was filled with spindle cell and foamy cell. Inflammation process involved the entire urinary bladder wall and penetrated through the serosal area. PAS stain and acid-fast stains failed to reveal any bacilli or fungus. Immunohistochemistry stain for CD 68, CD 163, SMA ALK and S-100 unveiled the spindle cells are of myofibroblastic origin and foamy cells are of histiocytic origin. The postoperative course was smooth. Except for mild urinary frequency, there was no postoperative complication. No recurrence was noted yet.

Conclusion:
Xanthogranulomatous cystitis is a very rare disease with only about 20 cases reported up to now. It is a benign chronic inflammation of unknown etiology. It could involve urinary bladder and adjacent organs. Thorough investigation of the whole abdomen is mandatory to make a correct treatment plan for this disease.

Memorial Hospital (Taiwan)
Purpose: The role of renal stone in the renal malignancy is not well known. The aim of the study is to evaluate if concomitant renal stone affects the outcome of renal malignancy or not.

Materials and methods:
From January 2000 to February 2009, 861 cases underwent radical nephrectomy in our institution and 32 cases had concomitant renal stone. 23 patients with the renal stone in the opposite site of renal malignancy were excluded. We substrated patients into two groups by renal cell carcinoma and urothelial carcinoma.

A273
The pathology of the specimen was also reviewed by the single pathologist. Student's T test and Chi-square were used to analyze the factors affecting the survival between two groups.
Results: Three patients are renal cell carcinoma (RCC) and the other 6 patients are urothelial carcinoma(UC). The mean age of patients with RCC is 59±7.2 and the UC is 66.5±5.0. There is no difference in the pre-operation serum creatine level(1.2 vs 1.3, p=0.25), glomerular filtration rate (58.8 vs 58.7, p=0.11), disease free survival(50 months vs 65 months, p=0.11) between RCC and UC group. Two patients of UC had advanced stage (T3a and T4) and progressed 2 months after radical surgery,and one died at 4 months and another died at 7 months later. No squamous cell carcinoma was found in our series.

Conclusion:
There is no difference in the presentation and outcome between renal cell carcinoma and urothelial carcinoma in patients with concomitant renal stone. The outcome of the patients with renal malignancy and concomitant renal stone depends on the stage of renal malignancy.

PP28-48
Colon cancer with adrenal metastasis: a case report Ying-Hsu Chang 1 , See-Tong Pang 1 , Kun-Lung Chuang 1 , Heng-Chang Chuang 1 , Cheng-Keng Chuang 1 1 Chang Gung Memorial Hospital (Taiwan) Purpose: Colon cancer frequently present with distant metastasis. Involvement of adrenal gland is quite rare. We reported a case of colon cancer with adrenal metastasis.
Case Report: A 76-year-old woman went to our OPD due to left adrenal tumor was noted. She was a case of ascending colon cancer has been received right hemicolectomy one year ago. Pathology revealed with adenocarcinoma, Duke s C3 with stage T4N2M0. Postoperative adjuvant chemotherapy was done. Regular abdominal CT follow up revealed solitary left adrenal mass.
Adrenal biopsy was done and metastasis adenocarcinoma was diagnosis. She received left adrenectomy. After then she was regular followed up at our OPD service. We will repot the clinical course and review the literatures.

Ming University (Taiwan)
Purpose: Metastatic prostatic cancer has a poor prognosis. Common metastatic sites are bones, lymph nodes, lung or liver. Metastases to rectum are rare. Herein, we report a case of prostate cancer with solitary rectal metastasis.
Case report: A 80-year-old male patient had past history of hypertension, coronary artery disease with triple vessel disease and type 2 diabetes mellitus. He suffered from acute urinary retention. Foley catheter indwelling was performed and he was referred to GU OPD, where elevated PSA about 4.75ng/ml and abnormal DRE was noted. TRUS and biopsy was done and the pathology showed adenocarcinoma of prostate, Gleason 4 3, bilateral lobes. Whole body bone scan revealed no bony metastasis. MRI showed bilateral seminal vesicle invasion and focal wall thickening of rectum. He was referred to CRS, where colonoscopy showed two tumor about 2cm and 0.2cm from anal verge about 10cm and 20cm respectively. Operation of radical proctectomy with low anterior resection was performed. The pathology revealed metastatic adenocarcinoma of prostate. The patient underwent antiandrogen therapy of leuprorelin. After initiating hormone ablation, the PSA level decreased to 0.11ng/ml within 2 months.

Conclusion:
Prostate cancer with solitary rectal metastasis is quite rare. Like other sites of metastasis, hormone ablation treatment is the first choice.

PP28-50
A case report and review of literature Tien-Huang Lin 1 , Hsin-Ho Liu 1 , Tsung-Hsun Tsai 1 , Shang-Sen Lee 1 1 Division of Uology, Buddist Tzu-Chi General Hospital (Taiwan) It is about 1% of patients with endometriosis have involvement of the urinary tract, with the bladder being the most common location. Ureteral endometriosis is very rare. Obstruction of the ureter may be caused by extrinsic or intrinsic disease. Progressive ureteral obstruction can be insidious in onset and ultimately lead to renal failure. Hormone therapy has had variable success, and open surgery has been the mainstay of treatment. This case of ureteral endometriosis was diagnosed with ureteroscopy at Chinese medical university hospital 2 years ago. She received 1st line hormonal therapy (danazol) at out patient department (OPD) GYN. She visited our OPD of urology last Apr because she suffered from flank pain, left-side and gross hematuria. Recurrent ureteral endometrosis was diagnosed with ureteroscopy. Computed Tomography (CT) revealed that obstruction of the ureter was caused by extrinsic or intrinsic endometrosis. This P t was treated ureteroscopic resection and leuprolide therapy. She remained asymptomatic after more than 12 months starting treatment.

PP28-51
Intra-testicular adenomatoid tumor : a case report and review of literature Tien-Huang Lin 1 , Hsin-Ho Liu 1 , Tsung-Hsun Tsai 1 , Shang-Sen Lee 1 1 Division of Uology, Buddist Tzu-Chi General Hospital (Taiwan) The evaluation of a scrotal mass includes a history, physical examination, scrotal ultrasonography and tumor markers. Scrotal tumors can be divided into those that are intratesticular and extra-testicular. Intra-testicular tumors are almost malignancy; benign intra-testicular tumors are very rare. Radical orchiectomy is indicated for intra-testicular solid tumor. Adenomatoid tumors are rare benign tumors of female and male genital tracts. Adenomatoid tumors account for approximatedly 30% of all paratesticular tumor, these tumors are most frequently location in the epididymis. We reported a case of intra-testicular soild tumor; benign tumor was considered. We reported the characteristics of ultrasonongraphy and magnetic resonance imaging (MRI). This patient received successful treatment with partial orchiectomy.

Case report:
The 63-year-old male patient suffered from lower urinary tract symptoms for many years with recent aggravation. Repeated urinary tract infection episodes were also noted. OPD visit revealed prostate adenocarcinoma by TRUS biopsy. MRI image showed cT3bN0Mx. Surgical castration with prostate gold marker implantation for IGRT was performed under spinal anesthesia. Pathology report showed intact testis but metastatic prostatic adenocarcinoma in epididymis.

PP28-53
Squamous cell carcinoma of the duplicated ureter: a case report A275 initially, and develop the squamous cell carcinoma after ten years later.

Materials and methods:
A 56-year-old man was diagnosed with the duplicated ureter for ten years without regular follow-up.He was referred to our hospital due to gross hematuria and flank pain, and the computed tomography showed the renal pelvis tumor in upper pole ureter. He received the nephroureterectomy and the final pathological disgnosis of squamous cell carcinoma of upper pole ureter with lymph node metastasis was made. After operation, he received the chemotheray and radiotherapy, but disease progession was still progressed after therapy. He died of dissminated malignancy later.

Conclusion:
The squamous cell carcinoma of duplicated renal pelvis is still a rare case. The outcome for patients with squamous cell carcinoma of the upper urinary tract was poor, and we reported our experiences to manage this patient.
Case report: The 71-year-old male patient suffered from gross painless hematuria off and on for 1 month. Renal echo in OPD showed right side renal mass with mild hydronephrosis and further MRU study showed suspected urothelial carcinoma. Right side nephroureterectomy was performed and further adjuvant chemotherapy was scheduled. Pathology report showed large cell neuroendocrine carcinoma. He was refered to oncology ward for further chemotherapy.

PP28-55
The value of transurethral resection of bladder tumor in one piece (TURBO) Hiroshi Ikeda 1 , Masayoshi Nomura 2 , Takehiko Shou 1 , Kaori Ishikawa 1 , Eiji Kashiwagi 1 , Hayato Sanefuji 1 , Kouji Okumura 3 1 Kitakyushu General Hospital, Fukuoka, (Japan) 2 Kameda Medical center, Chiba (Japan) 3 New Japan Steal Memorial Hospital, Fukuoka, (Japan) Purpose: Since Transurethral resection of bladder tumor in one piece (TURBO) was reported in the Journal of Urology in 2000 by Ukai, some urologists carried out TURBO. We analyzed treatment results of TURBO in our hospital and examined the value of this procedure.

Materials and methods:
A total of 14 patients with bladder tumors carried out TURBO under spinal anesthesia, in some cases blocking the obtulater nerve, from April 2006 to June 2009 in our hospital. The procedure is 1. point marking, 2. circular incision, 3. level incision and 4. specimen retrieval using a needle electrode in accordance with the Ukai s method. We investigated pathological findings, operation time and complications.
Results:1) It is possible to diagnose the precise pathlogical findings by TURBO. All resected edge had no cancer. There were no recurrence on the same location. 2) There were no complications during and after the operation. 3) Operation time of TURBO (35~223min) was longer than TUR-BT. 4) Urethral catheter holding period and hospitalization period after TURBO was the same as TUR-BT. 5) TURBO is a relatively safe procedure even for beginners.
Conclusion: TURBO is a safe and useful procedure that provides precise pathological findings with minimal complications. Second TUR is not necessary for TURBO. TURBO has a possibility to be gold standard of the treatment for non muscle invasive bladder cancer.

PP28-56
A comparison of pain tolerance and shockwave induced renal injury at different shockwave delivery rates within a same subject Purpose: Animal models have demonstrated that stone fragmentation is improved by slower shockwave delivery rate. However, the effect of different shock wave (SW) delivery rates on renal damage and pain experienced by patient were not known. Therefore, we would like to perform a within-subject comparison at different SW delivery rates.

Materials and methods:
This study is designed as a randomized two sequence, two-period 2×2 crossover clinical trial. Patients with solitary renal stones of size 5-20mm were treated with SWL treatment of Sonolith Vision (Technomed, France). Patients were randomized to receive either treatment at 60 SWs/min or 120 SWs/ min. Decision for retreatment was decided at the end of 12-week follow-up. If patient required re-treatment, the second treatment would be performed at another delivery rate (cross-over). During both treatments, spot urine was collected for the measurement of urinary level of Interleukin-18 (IL-18), neutrophil gelatinase-associated lipocalin and N-acetyl--D-glucosaminidase, for the quantification of. renal injury. Pain perception by patient was quantified by the usage of patient-controlled analgesia (PCA) and numeric rating scale (NRS) pain score. Patient preferences in terms of personal perception to both rates were also recorded at the end of the second SWL.
Results: 31 patients were recruited with 16 patients treated with 60 SWs/min (Group A) and 15 patients with 120 SWs/ min (Group B) first. All second treatments were performed after 12 weeks of the first session with all urinary markers back to baseline (wash-out period). All three markers were increased significantly at immediate post-treatment when compared to baseline levels (p<0.05), with urinary IL-18 levels significantly raised after 120 SWs/min treatment which suggested slower shockwave delivery rate resulted in more renal injury. Table below shows the change in biomarker levels in both groups. Despite, pain scores, PCA demand and PCA administrated were all statistically insignificant, pain score are consistently higher when treating with 120 SWs/min. The percentage of patient in favour of 60 SWs/min, 120SWs/min and no preference were 52%, 28% and 20% respectively.

Conclusion:
The present data reinforced our previous result that slower shockwave delivery rate contributed to greater pain tolerance but may not protect against SWL induce renal injury. Greater sample size is needed to verify our observation. Acute appendicits as a complication of extracorporeal shock wave lithotripsy is a rare condition and never been reported so far. There has been only two reported case of intestinal perforation due to ESWL. However, this complication should be taken into consideration where the patient has the history of abdominal surgery and where ESWL was performed with the patient in the prone position. There are no perforation could be detected laparoscopically, an appendectomy was performed. Postoperatively the patient had an uncomplicated hospital stay and was discharged home on postoperative day 3. The pathology reported as an acute congested appendicitis with early stage.
Conclusion: ESWL is considered a safe method to treat urinary lithiasis with a low complication rate. Nevertheless serious potentially life-threatening pararenal or intraabdominal complications can occur. Due to the increasing number of outpatient procedures, a careful clinical and ultrasound monitoring of the patient with early recognition and interdisciplinary management of complications is necessary after each ESWL therapy.

SL27D1
The growing interest and practice of clinical ethics in Taiwan Driven by the increased social expectation for better health care ethics and the requirement from hospital accreditation standard, the practice of clinical ethics through institutional mechanism such as clinical ethics committee (CEC) and ethics consultation has become a growing interest and challenge to hospital practice in Taiwan in the past 10 years. In 2008, we conducted a national survey on the development and practice of hospital ethics committee through self-reported questionnaire in all 73 hospitals which are classified as academic medical centers (19) and regional hospitals (54) in Taiwan. All 73 hospitals responded to the questionnaires and 52 (71%) of them had established CEC. 19 were academic medical centers and 33 were regional hospitals. The mean established time of the CEC in 19 academic medical centers was 8.96 years. The average number of CEC members was 15.6 persons and 83% of them were hospital members. Physicians are the predominant participants (53%), but nurses, hospital administrators, ethicists, attorneys, psychologist, social workers, lay people, and etc. are also represented in the CEC. The majority of the CECs held meetings every 3 months, and 38% of the CECs held emergent meetings mainly for reviewing organ transplantation, clinical trial, and case consultation. All CECs provided ethics education, 90% CECs developed hospital ethics policy, and 60% CECs performed ethics consultation. More academic medical hospitals had ethics consultation (84%) than regional hospitals (46%). However, these were mostly not regular or formal clinical ethics case consultations. 2 CECs in academic medical hospitals reported that they had 1-3 case consultations per month, but most of the CECs rarely had case consultations. The majority of these case consultations were firstly by direct response from CEC members through email or phone, secondly through regular or emergent committee discussions. Only 2 CECs reported that they have special consultation group for case consultations. In addition, 54% CECs reviewed organ transplantation, while 42% CECs reviewed clinical trials. The most common difficulties these CECs faced were insufficient manpower and qualified personnel for maintaining and promoting the CECs. Some CECs reported that members were too busy to join the self-education programs; some reported that their hospital employees paid insufficient attention to the CECs. Some reflect on these results will be provided in the conference. The ethics support project of "Taiwan Clinical Ethics Network (TCEN) will be introduced.

PP28-58
Radical cystectomy for urothelial carcinoma of the bladder:

11-year result of Tuen Mun Hospital
Man Hung Cheung 1 , Arthur Cheung Chi Kin 1 , Lam Kin Man 1 , Man Chi Wai 1 1 Division of Urology, Department of Surgery (Hong Kong) Objective: To review the outcomes of patient with CA bladder treated with radical cystectomy in the last eleven years.

Patients & Methods:
Ninety-six patients with urothelial carcinoma of bladder, treated with radical cystectomy in Tuen Mun Hospital from 1999 to 2010 were analysed for survival and recurrence.
Results: There were 96 patients included in the study, ranged from 41 to 86-year old; 84 males and 12 females, of which, 16 patients (16.6%) got superficial disease and 80 patients (83.3%) got muscle invasive CA bladder. Pelvic lymph node dissection was performed in 82 patients (85%), 29 of them (30%) had lymph node involvement and all of them were muscle invasive tumor. Sixty-six percent of patient had ileal conduit as urinary diversion while 33% had continence urinary diversion. There were 6 (6.3%) perioperative deaths (die within 30days of operation). Complications that required repeated operation in the early post-operative period occurred in 12 (12.5%) patients. The overall and recurrence-free survival rate at 5-year for superficial disease was 57% and 80% respectively, while those for muscle invasive disease was 28% and 39% respectively.

Conclusions:
The recurrence-free survival was much better in patients with superficial disease then muscle invasive disease (80% Vs 39%), indicating early treatment to highrisk superficial tumour could provide survival benefit.

PP28-59
Comparison of treatment outcomes of laparoscopic ureterolithotomy and ureteroscopic lithotripsy for upper ureteric calculi: an early result from a restrospective review

Materials and methods:
From April 2009 to March 2010, eleven patients were treated by ureteroscopic lithotripsy while eight patients were treated by laparoscopic ureterolithotomy. All ureteroscopic lithotripsy was performed by 7.5Fr semi-rigid ureteroscope under spinal anaesthesia or general anaesthesia. All laparoscopic ureterolithotomy has been performed via transperitoneal approach under general anaesethesia.

Results:
The mean age of ureteroscopic group and laparoscopic group was 50.8 years old and 57.8 years old respectively (independent t-test, p=0.77). The mean A279 stone size was 17.9mm and 21.3mm (Mann Whitley test, p=0.818). Laparoscopic group had a longer operative time. (187.6mins vs 78.5mins, Mann Whitley test p<0.01). The length of hospital stay was shorter in patients who underwent ureteroscopic lithotripsy. (1.6 days vs 5.7 days, Mann Whitley test, p<0.01). Laparoscopic approach achieved complete stone clearance in all patients. Two patients who were treated by ureteroscopic lithotripsy required auxiliary treatment for residual stone. No intraoperative complication was encountered in laparoscopic approach. A patient was found to have ureteric perforation during ureteroscopic lithotripsy. No post-operative sepsis was found in laparoscopic approach, in contrast, a patient was documented with post-operative fever and requiring intravenous antibiotic treatment. No conversion rate was found in laparoscopic approach.
Conclusion: Laparoscopic ureterolithotomy can achieve 100% complete stone clearance rate and reduce auxiliary treatment in the expense of longer hospital stay. Longer follow-up is required to evaluate late complications including ureteric stricture.

Hospital (Taiwan)
Results: Laser lithotripsy applied in the management of upper urinary tract stone has been emerging and considered a safe tool. However, we present a case of critical renal rupture with post-operative shock after ureteroscopic homium YAG laser lithotripsy. A 75 year-old male underwent ureteroscopic holmium: YAG laser lithotripsy for a left renal pelvic stone. Postoperative shock developed. Emergent image study showed left renal rupture with perirenal hematoma formation and one dropped stone outside the kidney. After aggressive intravenous fluid resuscitation, the patient s condition became stable. He was discharged and followed in the outpatient department 1 week later.

Recurrent urinary tract infection and bladder calculi in the presence of intravesical suture material after female antiincontinence surgery
Chung-Cheng Yu 1 , Sung-Lang Chen 1 , Gin-Dan Chen 2 , Soo-Cheen Ng 2 , Yu-Lin Kao 1 , Shao-Chuan Wang 1 1 Urology Department, Chung Shan Medical University Hospital (Taiwan) 2 Gynecology and Obstetric Department, Chung Shan Medical University Hospital (Taiwan) Purpose: We retrospectively reviewed the occurrence and management of recurrent urinary tract infection and bladder calculi in patients following anti-incontinence surgery at a single institution over 5-year period.

Materials and methods:
We reviewed the charts and encountered 6 who had recurrent urinary tract infection and encrusted bladder stones following by anti-incontinence surgery. The bladder stones were treated by electrohydraulic or lithoclast litholapaxy first and then extracted. The calcified sutures were cut as much as possible with transurethral endoscopic scissors.
Results: Mean age of the patient was 49.3±4.8 years. The duration between anti-incontinence surgery and bladder stone litholapaxy was 71.0±38.4 months. The mean encrusted foreign body bladder stone size was 1.9±0.6cm. The pyuria condition was improved after bladder stone management and intravesical foreign body removal.

Conclusion:
Recurrent urinary tract infection following gynecological obstetrical procedures should raises suspicious of iatrogenic intraoperative bladder penetration or sutures material migration and, therefore complete and thorough investigation is indicated, including cystoscopy.

PP28-62
Metabolic differences between the pediatric and adult patients with stone disease Purpose: In our study, we aimed to determine the metabolic risk factors in children and adults with stone disease and any differences between the metabolic risk factors of children and adult patients with stone disease. Between 1999 and2007, 285 adults with recurrent stone disease and 71 children with primary or recurrent urinary stone disease underwent metabolic evaluation in our clinic. The evaluation included blood chemistry studies, 24-hour urine collection, with 14 years of age as the limit, the pediatric and adult groups.

Results:
The mean age of the children was 9.35 years (range: 1-14 years ) and 42.1 years (range: 14-71) in the adult patients. Metabolic risk factors were demonstrated in 90.53 % (n= 258) of the adult and 88.73 % (n=63) of the pediatric patients. While hypercalciuria ( 50.5%, n=144) was found to be the most common metabolic risk factor in the adult group, hypocitraturia was found to be the most common metabolic risk factor in the pediatric group ( 57.74%, n=41). Furthermore, in the adult group,136 patients had more than one risk factor, and in the pediatric group, 24 patients had more than one risk factor.

Conclusion:
Although hypocitraturia is the most common risk factor in pediatric urolithiasis patients and hypercalciuria is the most common in adult patients. All the patients with stone formation should be performed a metabolic evaluation because such patients may also have a metabolic abnormality.

PP28-63
Laparoscopic unroofing and removal of left upper calyceal diverticular stone: a case report

PP28-65
Experience of standardized procedure of percutaneous nephrolithotomy for upper tract stones at a local hospital -2 days hospital course Ding-Yuan Chen 1 1 Division of Urology, Yu-Li Tsu-Chi Hospital (Taiwan) Purpose: Percutaneous nephrolithotomy (PCNL) has become the standard procedure for larger, complex upper tract urolithiasis, especially for those have poor response to extracorporeal shock wave lithotripsy (ESWL). However, the higher risk and complication rate than ESWL or ureteroscopic lithotripsy (URSL) definitely affected the judgments of Urologists and patients. We find that modification of usual habits of treatment made PCNL a simpler and acceptable procedure. Sono-guided puncture and one-stage PCNL was performed under general anesthesia. Two cases were excluded due to complications (one AMI, transfer after operation; one subphrenic abscess, prolong hospital stay) Modification in pre-operative preparation and and post-operative care was used in 2009. Pre-operation management such as controlling infection or ordering platelet for patients with thrombocytopenia. Antegrade pyelography study was done in 12-24hours,then we remove nephrostomy tube followed by urethral catheter. Double-J catheter was removed in 1-2 weeks at OPD.

Results:
We compare the patients before Aug. 2009 (27 cases as group 1) with the patients after Sep. 2009 (18 cases as group 2) in general data, hospital days and complication rate. Stone size 1.5-7.5cm. Under the new protocol, hospital stay in non-complicated cases decreased to 36-48 hours. No patient returned to hospital due to delayed bleeding. The average hospital day was 4.59 days in the group 1, and 2.85 days in the group 2. Complication rate will be discussed when more cases were collected.

Conclusion:
More than 85% of renal stones were managed with ESWL. However, PCNL is indicated in selected cases. The standardized procedure showed that PCNL is easily performed in most selected cases who recovered well and discharged from hospital in 18-36 hours after operation. In the new protocol, PCNL became a more comfortable operation procedure with same success rate and complication rate. Experience in identification of risk factors, case selection, preoperative management is very important to run the new protocol.

PP28-66
Sponteneous subcapsular renal hematoma as complication of ureterorenoscopy: 3 cases report and lierature review Purpose: Spontaneous subcapsular renal hematoma (SSRH) is uncommon and not usually suspected clinically with only 112 cases reported in the English literature. Ureterorenoscopy (URS) was never even hinted to be associated with SSRH among all the reported cases. We report here 4 units of SSRH in 3 cases after URS and review the literature.

Materials and methods:
We retrospectively reviewed the records of patients undergoing URS exam with or without stone manipulation in the same 9-month period when SSRH was encountered at our institute. History of trauma was carefully sought and excluded. SSRH was diagnosed and confirmed by ultrasound and computed tomography.

Results:
Among the 442 patients included in the study period, four renal units of SSRH in 3 patients (0.9%) were identified. The presenting symptoms included severe flank pain and gross hematuria 2-4 days after URS. Hydronephrosis was documented in all of the cases by sonography before URS. There was neither obvious perforation nor prolonged stone manipulation for all of the cases during URS. All of them had signs of internal hemorrhage (tachycardia and decreasing hemoglobin or hematocrit). Two of them were managed by percutaeous drainage while the other two were treated conservatively; all of them recovered well. Review of the literature showed that the leading cause of SSRH is idiopathic (30 cases or 26.8%), higher than tumor (28 cases or 25.0%), inflammation and infection (22 cases or 17.9 %), cyst (16 cases or 14.3%) and others. However, hydronephrosis was documented as etiology in 4 cases only.

Conclusion:
A not so uncommon incidence rate of SSRH after URS, 0.9%, was found in this study, which is higher than the reported stricture rate (0.1-0.7%) and is comparable to the reported perforation rate (0.5-3.3%). Hydronephrosis seems to be an important preceding factor and might account for the formation of subcapular hematoma because of the stretch-release force exerted on renal capsule after obstruction was relieved by URS. Therefore, though flank pain and hematuria developed after URS are not routinely taken seriously, accompanying signs of internal hemorrhage may warrant further image studies to rule out the possibility of subcapsular renal hematoma.

Role of percutaneous cystolithotripsy in treatment of bladder calculi
Tsung-Wei Wang 1 , Yen-Chuan Ou 2 , Chung-Kuang Su 2 1 Division of Urology, Department of General Surgery, Puli Christian Hospital (Taiwan) 2 Division of Urology, Departments of Surgery, Taichung Veterans General Hospital (Taiwan) Bladder calculi are not uncommon in Taiwan. There are three surgical approaches to this problem. They include transurethral cystolithotripsy (TUCL), percutaneous suprapubic cystolithotripsy (PCCL) and open suprapubic cystotomy. Vesical calculi in adult is usually managed by transurethral cystolithotripsy. In the past, percutaneous cystolithotomy usually is a safe alternative for children with large burden vesical stone. Recently, percutaneous cystolithotripsy is minimally invasive, decreases urethral and bladder mucosa injury, and can be used to remove bladder calculi in adult more than 3 cm successfully. It is an alternative with low morbidity and complication rate for treating large bladder calculi in adult and children. We describe a special case of multiple vesicle stones for the efficacy of percutaneous cystolithotripsy.

PP28-68
Right upper ureteral stone with severe hydronephrosis with presenting 2.0×1.2cm oval calcification in middle third of left ureteral course: a case report Hsing-Wei Huang 1 , Wen-Chou Lin 1 1 Department of Urology, Mackay Memorial Hospital (Taiwan) Introduction: The diagnosis of ureteral calculi usually depends on ultrasonography or confirmatory radiologic tests include abdominal plain film, intravenous pyelography (IVP), or even non-contrasted helical CT. In most situations, we can identify the radiopaque stones over the ureteral course by abdominal plain film. We introduce a case who had right upper ureteral stone with severe hydronephrosis presented in the abdominal plain film with the oval calcification in middle third of left ureteral course.
Case report: A 57-year-old male presented with mild right flank pain for months. Physical examination showed no obviously knocking pain over right flank area, but there was a palpable mass over right abdomen. Abdominal plain film revealed a 2.0×1.2cm oval calcification in mid-third of left ureteral course, suggestive of a left ureteral stone. However, the renal echo revealed severe right hydronephrosis with left compensatory hypertrophy. Abdominal CT was arranged and the report showed a big right upper ureteral stone leading severe hydronephrosis with shifting to left paraspinal area and very thinning cortex of right kidney. The right kidney was about 23.0×17.6 cm in size due to marked hydronephrosis. After the diagnosis was confirmed, the patient received right percutaneous nephrostolithotripsy (PCNL) and double-J insertion.

Discussion:
Ureteral stone disease is a common problem in primary care practice. Most urologists in Taiwan use KUB or ultrasonography as the first choice of diagnostic method for detection of stone disease. However, in this case, the presentation of abdominal pain film and ultrasonography are different. It s implied that only KUB examination may lead to misdiagnosis and need clinical correlation. Hence, the complete history taking, physical examination and use multi-modalities assistant may help clinicians to get more precise diagnosis.

Conclusion:
The use of multi-modalities diagnostic tools may be indicated if there are incongruous results between the clinical presentation and radiologic tests. Of course, complete history taking and physical examination cannot be ignored.

PP28-69
Thirteen pleural injuries in 905 percutaneous nephrolithotomy patients: ChiaYi Christian Hospital experiences Chang-Te Lin 1 , Ming-Chin Cheng 1 , Chang-Huang Shen 1 , Yeong-Chin Jou 1 , Pi-Che Chen 1 1 Department of Urology, Chiayi Christian Hospital (Taiwan) Purpose: Pleural injury is a major complication of percutaneous nephrolithotomy (PNL). And it is a disaster to urologists and patients. How to prevent, detect, and to be familial with clinical manifestations are very important. In this study we will present our experience of 13 pleural injury cases in 905 percutaneous nephrolithotomy performances.

Materials and methods: From 2000 March to 2009
December, we have performed 905 PNLs, 98 of these procedures were performed in 11th intercostals space. Unfortunately, there were 13 pleural injury cases. We recorded patients characteristics such as age, sex, body weight, stone size, stone location, and clinical manifestations such as early symptoms, operation duration, blood transfusion, hospital stay, stone free, underline diseases, and other complications by retrospective chart review. And Divide patients into pleural injury (group 1) and non-pleural injury (group 2) and compare with variations of clinical manifestations.

Results:
There was no significance difference about age, sex, and stone size, stone location, and body weight between 2 groups. But there was longer operation time (74.5 vs. 81.6 minuts), and high incidence of blood transfusion (83.3%) and hospital stay (2.7 vs.13.8 dyas) in group 1. And supracostal access is a risk factor (12/13, 92.3%), and ipsillateral shoulder pain (38.4%) , chest pain (30.7%), and breathing with exertion (23.0%) were the most important early symptoms to detect pleural injury. But particularly there was no any symptom in 2 cases and pleural injuries were found by postoperative chest X ray. Early chest X ray were suggested by textbook , but there were 3 cases with delayed pneumothorax and delayed hydrothorax. Eleven of 13 cases need chest tube insertion as treatment. All 13 cases recovered, and there were no significant sequelae after management.
Conclusion: Supracostal access was a risk factor. And closely observe symptoms and follow up chest X ray successively is important to detect the pleural injury. There were longer hospital stay, operation time, and high incidence of blood transfusion in clinical manifestations of pleural injury of PNLs. But we must keep in mind that there were many variations in clinical course of pleural injury of PNLs.

Experience of posterior lumbotomy approach for larger upj and upper ureteral stones
Ding-Yuan Chen 1 1 Division of Urology, Yu-Li Tsu-Chi Hospital (Taiwan) Purpose: Endoscopic surgery (either percutaneous nephrolithotomy or ureteroscopy with lithotripsy) had become popular procedure for most upper tract urolithiasis. However, some larger stones with long-termed obstruction, polyps formation and distort ureter which may result in failure of surgery, residual stones, ureteral injury, and possible renal function loss. We reviewed our patients retrospectively and tried to clarify the role of this open procedure by comparing to the ureteroscopy and ESWL in both success rate and complication rate.

Materials and methods:
Since 2000 to 2010, there were 15 patients (M:F=11:4) who received posterior lumbotomy incision and retroperitoneal approach for upper ureteral stones (L2 to L5 level) by one urologist. One metal mark at back with plain x-ray was taken just before operation. Portable x-ray or C-arm was helpful to locate stone when the stone migrated (or pushed back) to renal pelvis during manipulation. The ureteral stone was grasped with Babcock forceps, then it was delivered to more superficial position where further procedures (lithotomy, double-J insertion. and water-tied the ureteral wall) were easily performed. At the end of operation, one J-P drain was inserted beside the ureter.

Results:
The success rate was 100% (all stones were found and removed). Only one patient converted to peylolithotomy (still by lumbotomy approach) because the stone (3.5 cm in size) upward migrated to renal pelvis after general anesthesia. All patients could leave bed on the next morning by themselves. The most common complication was wound pain, but limited in mild degree which could be managed with oral NSAIDs. No fever or sepsis. Only 2 (13.3%) cases of temporary urine leakage in the first 24 hours after operation. The average hospital stay was 3.5 days (2-5 days) Conclusion: By advancements in modern technology and new equipment, more options are available for surgeon and patients. Even the most expert urologist will confront some unexpected iatrogenic injury created by endoscopic surgery. Some severe injuries even lead to irreversible damage to both ureter and kidney. For any reasons, young urologists practice endoscopic surgery every day. Is there still any role of the open surgery? In our experience, lumbotomy exploration of retroperitoneal space for larger, impacted upper ureteral and UPJ stones is a safe and effective procedure with minimal wound pain and less complication.

PP28-71
A ring-shaped stone in a female urethral diverticulum The classic presentation of urethra diverticula has been described historically as the"3Ds,"meaning dysuria, dyspareunia and dribbling. As the symptoms are not specific, the urethral diverticulum may often be misdiagnosed. We report a case of a ring-shaped stone in a female urethral diverticulum which was successfully treated surgically.
Case report: A 67-year-old female had had cervical A285 cancer and received a radical hysterectomy 20 years previously. She complained about a slow urine stream, hesitancy, straining when voiding, the feeling of incomplete emptying, and nocturnal incontinence. She was referred to our urological department for further examinations. Urine analysis revealed normal results. A plain X-ray of the lower abdomen demonstrated several high density nodules in the pelvic cavity. Difficulty in passing instruments was noted due to the stiffness of urethra during the urethrocystoscopy. Meanwhile, bladder stones were detected. Although a suburethral mass can be palpable around the urethra, no opening of the diverticulum could be seen during the urethrocystoscopy. Pelvic computerized tomography was performed and ring-shape diverticular stones were confirmed ( Figure 1). She received endoscopic cystolithotripsy, diverticulectomy of the urethra diverticulum through transvaginal excision and evacuation of the diverticular stones under epidural anesthesia. The diverticular stones ( Figure 2) were dirty yellow with a granular surface, and 18.5 grams in weight. The infrared spectroscopic analysis revealed that the stones were composed of carbonate-apatite and magnesium ammonium phosphate hexahydrate. She recovered well and had an uneventful postoperative course. The urine catheter was removed three days after surgery. No bothersome nocturnal incontinence or voiding difficulty occurred in the followup. The patient was still continent three years after surgery and no recurrence of diverticulum occurred.

Renal nerves regulate anticrystallization molecule expression in rat kidneys with CaOx nephrolithiasis
Ho-Shiang Huang 1 , Ming-Chieh Ma 2 1 Department of Urology, National Taiwan University Hospital (Taiwan) 2 School of Medicine, Fu-Jen Catholic University (Taiwan) Purpose:We previously showed that poor renorenal reflex in rat hyperoxaluric kidneys elevates renal sympathetic nerve activitywhen compared to the controls. Moreover, intrarenal expressions of anticrystallization molecule Tomm-Horsfall protein (THP) and osteopontin (OPN) are attenuated in the hyperoxaluric kidneys. We therefore ask whether renal nerves play a role in regulation of THP or OPN expression via the effect of adrenoreceptor and subsequently contribute to calcium oxalate (CaOx) crystal formation.

Materials and methods:
Male Wistar rats fed with 5% hydroxyl-L-proline (HP) for 28 days to induce hyperoxaluria and CaOx crystal deposition; control rats were given standard diet. Surgical denervation (DNX) in bilateral kidneys of control and HP rats was conducted after 7-da hyperoxaluric induction. Another group of DNX rats were given norepinephrine (NE) chronically via a subcutaneous mini-osmotic pump. Urine was collected for 24 hours from metabolic cage. Renal expression of OPN, THP, 1, and 2 receptors were further examined by Western blot or imunofluorescent labeling.

Results:
Daily urine amount is similar between control and HP groups, however urinary CaOx sediment and the score of CaOx crystal deposition are increased in HP rats. Although daily urine output is enhanced, high urinary amount of sediment and severe crystal deposition are still seen in the DNX-treated HP group as compared to untreated HP group. Compared to controls, HP kidneys have low levels of THP and OPN which further attenuated by DNX treatment. Both α1 and α2 receptor expressions are slightly decreased in HP kidneys but largely upregulated in DNX-treated HP kidneys. Given NE to DNX+HP rats normalize α1 and α2 receptor expression and increases the levels of THP and OPN in kidneys, this associates with an attenuation of crystal deposition.

Conclusion:
Our results clearly indicated that enhanced function of renal nerves in the hyperoxaluric kidneys is necessary to further prevent CaOx formation because removal of renal nerves by DNX aggregates crystal formation. The beneficial effect of renal nerves on prevention of CaOX crystal formation possibly relies on receptor activation which may affect anticrystallization molecule expression.

Menace behind giant bladder stone
Huang-Ching Chang, Guang-Huan Sun, Dah-Shyong Yu, Sun-Yuan Chang, Tai-Lung Cha (Taiwan) Purpose: Bladder stone is not uncommon in developing countries, but accompanying with squamous cell carcinoma of bladder is rare. The clinical atypical presentation, such as dysuria, urinary incontinence, and fever, may confuse doctors.

Materials and methods:
We report the case of a 80-yearold woman who had intermittent bilateral flank soreness, repeated dysuria and fever since 2 years ago, and treated as urinary tract infection at local medical clinic for a long time.

Results:
The symptoms were shown to result from neuropathic bladder after pelvic surgery, resulting in repeated urinary tract infection, and formation of a giant bladder stone and malignant tumor.

Conclusion:
In conclusion, we would like to emphasize that bladder cancer should be also considered in woman with a long history of urinary incontinence and repeated urinary tract infection.

PP28-74
Recurrent nephrolithiasis due to an occult parathyroid adenoma: case report Nephrolithiasis is a common disease, and recurrent nephrolithiasis can cause a significant financial impact on the patients as well as the community. Parathyroid adenoma is a rare cause of nephrolithiasis because it is not a common disease. The possibility of parathyroid adenoma is therefore often overlooked in patients with nephrolithiasis. The authors presented a case of recurrent nephrolithiasis caused by an occult parathyroid adenoma to remind urologists of this rare disease entity that can lead to recurrent nephrolithiasis. A 62 years old female had suffered from recurrent nephrolithiasis and urinary tract infection during the past decade before she visited our clinic. She had received numerous sessions of treatments, including extracorporeal shock wave lithotripsy, ureteroscopic lithotripsy and percutaneous nephrolithotripsy for recurrent nephrolithiasis of both kidneys over the past ten years. The laboratory test revealed increased level of parathyroid hormone, hypercalcemia and decreased phosphorous levels. Ultrasound examination of the neck, parathyroid CT, and Technetium99m-Sestamibi scintigraphy confirmed the presence of an occult parathyroid adenoma. The patient was then subjected to surgical excision of the parathyroid adenoma. The postoperative recovery was uneventful. Normalization of parathyroid hormone and calcium levels after surgery was achieved. She is stable at 6 months follow-up with no clinically significant recurrent nephrolithiasis. The authors recommend that systematic etiological work-up for hyperparathyroidism is indicated for all patients with recurrent nephrolithiasis. Purpose: Lower ureter is the most common site of stone trapp cousing renal colic and hydroureteronephrosis leading to renaldys function. If medical therapy is not effective, the treatment consist of ESWL, TUL or on rare cases, open surgery. This study is a research about the optimum treatment for lower ureteral stones which do not responed to medical treatment.

Materials and methods:
Sixty patients with obstructive lower ureteral stones for more than 3 weeks, that have not responded to medical treatment , were divided in to two groups. 30 patients underwent ESWL and the others TUL. Patients were between 18-72 years old, 41 male and 19 female. ESWL was performed by a single person with dornier MPL 9000in so patients.. In 14 of them the stone was broken and passed out , but in 13 patients the stone was not broken and in other 3 patients the stone was broken but its particles did not pass, these 3 ones underwent TUL after these operation. 15 patients had renal colic requiring analgesic the patients stones passed without any complications. In 28 of 30 patients who underwent TUL we could successfully access to the stone. In all of these patients the stone was broken to particles small enough to passed out. In 16 patients stone particles were removed with forceps. Since we couldn t access the stone in two patients, hey become candidates for ESWL. We used pneumatic or ultrasonic lithotripsy for TUL after these procedures, Renal colic occurred in 7 patients and fever in 3 patients which all cured with medical treatment.
Results: In 56.5% of patients who nderwent ESWL for lower ureteral stone, the stone was broken and its particles but in 43.5% of them the stone was not broken and they become candidate TUL. We valuated the success of procedure by sonography and KUB. The only complication of ESWL was renal colic which was cured by medical treatment. In 93.5% of patients who underwent TUL the stone was broken and its particles passed out or removed, but in 6.5% the procedure was not successful and the patients underwent ESWL or open surgery. Some patients experienced fever and colicy pain , who underwent medical treatment.
Conclusion: TUL is an intrusive procedure and, its complications are more than ESWL, but has a high success rate. In lower ureteral stones ESWL is less successful than TUL. Although ESWL is a noninvasive procedure, because of lower cost and high stone free-rate in TUL, we recomment TUL as the first option for treatment of lower ureteral stones.

Results:
Obtained results indicated that post operation complications in tubeless method such as hematoma, bleeding and fevered infection were 16.6%, 3.3% and 6.7% respectively.The complications for standard method such as fevered infection and pelvic rupture were 13.3%, 16.6% respectively. Also in operation with tubeless method the duration of operation and hospitalization were shorter than the subjects operated by standard method. This, in turn, resulted in less costs for treatment.

Conclusion:
The tubeless PCNL method is more effective than standard method that surgeon may use it optionally for the patients without pelvic rupture and bleeding.

Departments of Urology, Kuo General Hospital (Taiwan)
Purpose: To report our recent experience in managing patients with long-forgotten ureteral stents that resulted in signific a nt s tent-related morbidi t y, i n c l u d i n g urosepsis, obstructive uropathy, stent encrustations and fragmentations.

Materials and methods:
A retrospective review was undertaken and four long-forgotten ureteral stents in three patients were managed in our department during a 3-year period. The inclusion criterion was a stent that required some form of intervention above the ureteral orifice to remove it. Combinations of extracorporeal shock wave lithotripsy (ESWL), ureteroscopy, and cystolitholapaxy were used to achieve stent removal.

Results:
The average patient age was 69.9 years (range 63-73 years). The average interval the stent had been in place was 36 months (range 12-84 months). All patients were not aware of the indwelling ureteral stents after previous endo-urological procedures when stents were inserted. Two of them were presented to our service with urosepsis, and one was noted incidentally with severe hydronephrosis. All patients are presented with severely encrusted ureteral stents in both proximal and distal coils. Two of them had multiple fragmented stents. Prior to planning definitive therapy, a plain radiograph with tomographic views was reviewed. All patients required 2 to 3 endourological approaches (average 2.6) performed at multiple sessions to render them stone-free and stent-free.
Conclusion: Long-forgotten ureteral stents can pose a serious challenge to the urologists, and indwelling times should be minimized to avoid problems. Prevention is, of course, ideal, but such cases are still seen despite increasing awareness. Patients often require multiple treatments and a combination of extracorporeal shock wave lithotripsy and ureteroscopy offers highly successful outcomes and often avoids the need for more invasive techniques.

PP28-78
Impact of extracorporeal shock wave lithotripsy on heart rate variability in patients with urolithiasis A289 (HRV) represents an index of balance in autonomous nerve.
The aim of this study was to evaluate the HRV during shockwave treatment in patients with urolothiasis.

Materials and methods:
Eighty-four patients who underwent ESWL treatment were completed with electrocardiograph record. Recording points were 10-minute before treatment, 5minute after treatment, shockwave number reached 2,000 shocks, and 5 minute after the treatment. ECG has been recorded continuously for six minutes on each point. And then R-R intervals were extracted. The time digital sequence made from R-R intervals was HRV signal.

Results:
In the time domain analysis, we found that MRR and SDNN but not RMSSD or TINN were significantly increased during ESWL. The SDNN kept elevated but the MRR returned to the initial level after ESWL treatment.
In the frequency domain analysis, the VLF, LF, and LF/ HF ratio were all significantly increased after ESWL. In contrast, there was no statistically significant difference in HF parameter.

Conclusion:
The patients had significantly higher HRV parameters (MRR and SDNN) during ESWL, and had significantly higher HRV parameters (SDNN, VLF, LF, and LF/HF ration) after ESWL. ESWL was able to alter the cardiac autonomic nervous system, resulting in a reduction in sympathetic activity and an increase in parasympathetic activity. Further studies need to be done on a larger sample to confirm these findings and to understand the underlying mechanisms.

PP28-79
Combination of lower pole anatomic features in a single infundibulopelvic index can predict the lower pole stone clearance more accurately after shock wave lithotripsy Bora Kupeli 1 , Serhat Gurocak 1 , Cenk Acar 1 , Iyimser Ure 1 , Ustunol Karaoglan 1 1 Gazi University School of Medicine, Department of Urology (Turkey) Purpose: To investigate whether the combination of lower pole pelvicaliceal anatomic features in a single index can predict the outcome of shock wave lithotripsy treatment (SWL) of lower caliceal stones more accurately instead of considering every single anatomic feature alone.

Materials and methods:
The clinical records of patients with lower caliceal stones who underwent SWL treatment between 2002-2008 were reviewed. After excluding patients with ureteropelvic obstruction, major renal anatomic abnormalities, non-calcium stones, metabolic abnormalities, history of recurrent stone disease, multiple stones and previous renal surgery; 96 patients were enrolled into study. The stones were in right side in 46 patients (47.9%) and left side in 50 patients (52.1%). Lower pole infundibulopelvic angle (IPA), infundibular length(IL) and width(IW) were measured from intravenous pyelography (IVP). Also, the surface area of the renal collecting system was measured using a 1 mm 2 grid paper and pyelocaliceal volume was calculated with a formula described before. From all these data infundibulopelvic index (IPI) was calculated as (IPA × IW ×100) / (IL × stone size×pelvicaliceal volume).

Results:
The mean stone size was 98.9±80.9mm 2. Overall stone-free rate was 67.7%. There were no statistically significant difference in IPA, IL and IW values between patients with residual stones and stone-free patients, respectively (p=0.81, p=0.08, p=0.82). Also no statistically significant difference were found in stone size (p=0.75), total pelvicaliceal volume (p=0.68) and SWL parameters. However IPI index was significantly different between two patient groups (p=0.05).

Conclusion:
We conclude that although every single anatomic variation might have some effect on the SWL outcome of lower caliceal stones in patient basis, combination of all these anatomic parameters with the stone size in a single index could be a more accurate predictive tool because every single anatomic feature was a part of whole.

PP28-80
Evaluation of urinary stone composition by use helical CT scan Results: from 120 stone, 17 were uric acid, (mean density 680hu) 57 were calcium oxalate (mean density 1815hu), 27 were calcium phosphate (mean density 1745hu), 8 were mixed (mean density 850hu) and 5 struvite (mean density 997hu) and 6 were cystin (mean density 1123hu). The differences in radio density of the stones were statistically significant. The management of calculus disease may be facilitated by ascertaining the stone composition.
Conclusion: we demonstrated that chemical composition of urinary stones could be predicted in vivo, using helical CTs .knowing the composition of a urinary stone may be a key factor in determining its appropriate management.

Ming University (Taiwan)
Paraganglioma of the bladder is a neoplasm derived from paraganglion cells in the bladder wall. They are histologically identical to paraganliomas at other sites. The commonly cited incidence of bladder paragangliomas is 0.06-0.10%. They are a little more common in female by 1.4:1. The clinical triad of sustained or paroxysmal hypertension, intermittent gross hematuria and micturition attacks is the characteristic feature. A 8 6 y /o mal e w as ad mit ted t o o u r w ar d d u e t o asymptomatic gross hematuria. There was no postvoiding headache, palpitation, and cold sweating. Besides, the hypertension history since 1973 was also noted. CT scan showed one soft tissue nodule at right bladder wall measured 2.4×1.7cm. Hence, transurethral resection of bladder tumor was performed and pathology disclosed paraganglioma of urinary bladder. Mitotic figure is rarely seen. The tumor cells are immunoreactive to chromogranin A and synaptophysin, but of monotonous spindle cells with pale cytoplasm. After the operation, the radiotherapy was added. Paraganglioma of the urinary bladder is very A291 rare. Physicians should be aware of the possibility of paraganglioma of urinary bladder without typical initial presentation.

Ming University (Taiwan)
Adrenal hemorrhage is a relatively uncommon condition that may lead to acute adrenal crisis, shock, and death unless it is recognized promptly and treated appropriately. We presented one case of bilateral adrenal hemorrhagic cysts that mimic malignant tumor. A 67 year-old male had the underlying disease of hypertension, congestive heart failure, type 2 diabetes mellitus, dyslipidemia and status post splenectomy due to trauma for 30 years ago. He suffered from epigastric pain for 3 months and denied trauma history during this period and gastric ulcer was diagnosed at local clinic. Then, proton pump inhibitor was taken for 3 months but in vain and then a right side abdominal tumor adjacent to liver and kidney was told by sonogram at local clinic. Abdominal CT was done but he lost to follow up for the report. Then, he visited our GI outpatient department for further help. Abdomincal songram disclosed right hepatic cystic lesion with 9.7×6.4cm in size and abscess formation can t be ruled out and one heterogeneous tumor with 6.8×7cm in size over right perirenal space. Then, he was admitted for further management. Physical examinations were all unremarkable. Secondapplied CT showed one right 7.3×6cm adrenal suprarenal tumor with liver invasion and multiple mediastinal lymph nodes, suspected malignancy. Tumor markers as AFP, CEA, CA-199 were checked and all were within normal limit as well as hormone profile including aldosterone, ACTH, cortisol and catecholamine. Bone scan showed negative for bony metastasis. Due to suspected malignancy, right adrenalectomy and liver S7 subsegmentectomy was done later. Pathology disclosed adrenal hemorrhagic cyst with liver involvement. Post-op condition was uneventful and he discharged under stable condition. One month later; however, he experienced acute onset of left flank pain and called on ER for help and he was admitted later. Abdominal CT disclosed one enlarged left adrenal tumor but hemorrhagic cyst was suspected according previous experience and supportive care was suggested. Then, he discharged under stable condition. Causes of nontraumatic adrenal hemorrhage can be classified into five categories: (a) stress, (b) hemorrhagic diathesis or coagulopathy, (c) neonatal stress, (d) underlying adrenal tumors, and (e) idiopathic disease. Bilateral adrenal hemorrhage is a rare catastrophic condition that manifests with acute adrenal insufficiency due to irreversible destruction of the adrenal cortices. It is uniformly fatal if glucocorticoid treatment is not initiated shortly after onset of the crisis but can be very difficult to diagnose prospectively because of its nonspecific symptoms.

PP29-2
The nadir PSA level is a significant prognostic factor in Taiwanese men with bone metastatic prostate cancer Purpose: The proportion of men with metastatic disease at first diagnosis is greater in Taiwanese men than in American men. Taiwanese men with metastatic prostate cancer might have a better survival compared with Western men. Pretreatment prostate-specific antigen (PSA) level occasionally fail to reflect the prognostic outcome. We investigated various clinical parameters in patients with bone metastatic prostate cancer and determine whether the nadir PSA level after treatment can be used as a prognostic factor.

Materials and methods:
We retrospectively reviewed 257 consecutive patients initially diagnosed with bone metastatic prostate cancer, who were treated in Taichung Veterans General Hospital from 1983 to 2008. Survival curves were generated using the Kaplan-Meier method. Cox regression analysis was used to analyze the clinical factors of survival associations, including age, performance status, clinical presentation, castration testosterone level, and serologic markers, and the relative efficacy of the nadir PSA level in predicting prognosis.

Results:
The 5-year overall survival rate using the Kaplan-Meier method for all 257 patients was 60.0%. The 5-year survival rate was lower in patients with nadir PSA nadir level > 10 ng/ml (P_ 0.113): 70% and 52% in those with PSA nadir level of less than 1 and greater than 10, respectively. On multivariate analysis using the proportional hazards model, the statistically significant prognostic factors of overall survival were the nadir PSA level > 10 ng/ ml (P _ 0.003), and maximum androgen blockade therapy (P _ 0.003).

Conclusion:
The nadir PSA level is a valuable prognostic factor for survival in patients initially diagnosed with bone metastatic prostate cancer.

PP29-3
Human gene polymorphism and response to bacillus calmetteguerin immunotherapy for superficial bladder cancer Purpose: The NRAMP1 gene has been implicated in susceptibility to tuberculosis and to BCG response in murine models. The Human glutathione peroxidase 1 (hGPX1) is a selenium-dependent enzyme that participates in detoxification of hydrogen peroxide, organic peroxides, and possibly cigarette smoke-derived oxidative radicals.
An association between hGPX1 and NRAMP1, and bladder cancer recurrence has been suggested. We aim to determine the predictive value of NRAMP1 and hGPX1 gene polymorphisms in superficial bladder cancer recurrence and response to BCG therapy. while the A:G genotyope was protective. Overall, the D534N G:G genotype had increased cancer-specific death (p=0.036). Overall, the hGPX1 CC genotype was shown to be protective, while the variant CT genotype (Pro/Leu) was associated with increased bladder cancer recurrence and decreased time to recurrence (p=0.03) after BCG therapy.

Materials and methods:
The hGPX1 CT genotype was also had shorter recurrencefree survival (p<0.001), progression-free survival (p<0.001) and associated with higher cancer-specific mortality in patients treated with a combination of BCG and IFNa.

Conclusion:
Our findings suggest that polymorpisms in the NRAMP1 and hGPX1 genes correlate with response to BCG therapy in bladder cancer patients. They may serve as molecular markers to predict BCG failure and cancer recurrence. Abdominal CT scan examination for stage showed suspected urinary bladder tumor with direct invasion of sigmoid colon and fistula formation. Therefore colonofiberscopy was performed but adenocarcinoma of sigmoid colon was found. The doctor of general surgery was consulted for the operation of low anterior resection and partial cystectomy.
Final pathology showed adenocarcinoma of sigmoid colon with urinary bladder invasion (T4b) and regional lymph nodes metastasis (1/27, N1a). Chemotherapy with FOlFOX was prescribing now. Purpose: Nephroureterectomy with bladder-cuff removal is the standard treatment for upper urinary tract TCC. Therapeutic approaches have evolved to minimally invasive ureterorenoscopic therapy in selected cases for preserving renal function. The introduction of lasers represented a big step in the endoscopic treatment of upper urinary tract tumors. We will present the experience of retrograde laserablation with ureterorenoscope for upper urinary tract tumors in our hospital.

Materials and methods:
During a 2-year period, 4 patients with upper urinary tract transitional cell carcinoma were treated with laser endoscopic therapy. All patients underwent retrograde ureteropyeloscopy. Lesions were biopsied, including one lower grade and three high grade tumors. Surveillance was performed at 3 to 4-month intervals by urine cytology and repeat panendoscopy.
Results: There were no perioperative complications associated with these procedures. Within the follow-up period, there was no recurrent tumor of the case of low grade tumor. Two cases of high grade group had recurrence of tumors and finally received nephroureterectomy. The other case of high grade group expired due to bronchogenic carcinoma which was diagnosed at the same time with urinary tract transitional cell carcinoma.

Conclusion:
Patients with high-grade lesions defined endoscopically should be offered radical surgery in light of the high rate of disease progression. Laser endoscopic therapy can be preserved for selected cases such as with low grade tumor. A careful endoscopic surveillance is mandatory, because of high frequency of local recurrences.

PP29-7
Primary synovial sarcoma of prostate, report of a case Ching-Wei Yang 1,2 , Kuan-Kuo Chen 1 , Yen-Hua Chang 1,2 , Alex Tong-Long Lin 1,2 1 Division of Urology, Department of Surgery, Taipei Veterans General Hospital (Taiwan) 2 Department of Urology, National Yang-Ming University, School of Medicine (Taiwan) Synovial sarcoma is a tumor of uncertain histogenesis and has been shown to account for 8% of all soft-tissue sarcomas. Its typical presentation is in the para-articular soft tissues of the lower extremities in young adults. Synovial sarcoma arising from the prostatic region is extremely rare. To our knowledge, only 7 reports of synovial sarcoma involving the prostate have been previously published.
Herein, we report a 45 year-old diagnosed of primary synovial sarcoma arising within prostate parenchyma and review the literature.

PP29-8
Phase II study of docetaxel and thalidomide in Japanese patients with prostate cancer refractory to hormone and DEC (docetaxel, estramustine phosphate, and carboplatin) therapy following effective treatment for docetaxel refractory patients is discussed. In our department, to determine the safety and efficacy of combination chemotherapy with DT (Docetaxel and Thalidomide), DT therapy was performed on the HRPC patients who had received DEC (Docetaxel, Estramustine phosphate, and Carboplatin) therapy and had become refractory to the therapy.

Materials and methods:
This study included a total of 13 HRPC patients. The following schedule was used: daily Thalidomide 100-800 mg po and Docetaxel 30 mg/m2 iv on day 1, 8, and 15 of every 4-week cycle. Treatment was continued until disease progression or excessive toxicity.

Results:
The median patient age was 70 yr (range: 55-82). The median pretreatment PSA level was 598 ng/ml (range: 4.4-14226.1). A median of three consecutive cycles of therapy was administered per patient (range: 1-12 cycles). Of 13 patients, 12 had a PSA decline. PSA levels decreased by more than 50% in 30.8% of the patients and by more than 75% in 15.4% of the patients as a maximum response. The median rate of PSA decrease was 26.1% (range:0-93). The mean overall survival time was 7.9 months, and the median time to progression was 2.7 months. All of the patients were assessable for toxicity. Most adverse events were mild in intensity. Major toxicities related to thalidomide consisted of grade 2 somnolence and general fatigue.

Conclusion:
Combination chemotherapy with DOC/ Thalidomide was found to have some efficacy with an acceptable toxicity profile in HRPC patients. Further studies are necessary to evaluate clinical benefit and the adverse effects of this regimen.

IGF-I and VEGF level in bladder tumor
Huang hongwei 1 , Li yun 1 , Fu yingyuan 1 , Shi yinchuan 1 1 Department of Urology, The Second Affiliated Hospital of Medical College of Nanchang University (China) Purpose: To investigate Serum levels of insulin like growth factor 1(IGF-1) and vascular endothelial growth factor (VEGF) in the pre-operation and post-operation patients with bladder tumor and its clinical significance.
Materials and methods: ELISA method was used to examine the serum levels of IGF-1 and VEGF in 48 cases of bladder tumor and 50 cases of normal people as contro1.The change of IGF-1 and VEGF serum levels in the pre-operation and post-operation patients with bladder tumor was also compared,and the differences of IGF-1 and VEGF serum level with bladder tumor patients in different pathology grade and invasion depth of tumor were observed.

Results:
In spite of pre-operation,and 7 days of postoperation,the IGF-1 and VEGF levels in serum of the patients was higher than that of the normal people;but IGF-1and VEGF levels decreased obviously after operation. In addition,the serum IGF-1 and VEGF levels were related to the pathology grade and invasion depth of tumor, At the same time the VEGF levels in serum of patients with bladder tumor would be enhanced as the IGF-1 level enhancing.

Conclusion:
It is obvious clinical significance to assess the sitution of tumor evolution, therapeutic effect and developmentment by detecting IGF-1 and VEGF serum levels.
Key Words: insulin like growth factor 1; vascular endothelial growth factor; bladder tumor.

PP29-10
Extra medulary plasmacytoma of the urethra Alireza Nouri 1 , Mryam Alsadat Ghorshi 1 , Pegah Nouri 1 1 Islamic Azad University Tehran Medical Branch (Iran) Purpose: Plasmacytomas of the urethra are extremely rare neoplasias; they may occur as isolated tumors or concomitantly with generalized multiple myeloma. Herein, we describe the clinical presentation and characteristics of a patient with primary plasmacytoma of the urethra.
Results: This case report discusses a case of a male patient suffering from plasmocytoma of the urethra, who could be treated successfully by primary surgical ablation and the patient is disease-free without any adjuvant therapy-after a follow-up of 36 months.
Conclusion: Primary localization of extramedullary plasmocytoma in the genitourinary tract is very rare. Although it is a relatively rare disease, primary urethral plasmacystoma would be treated successfully by primary surgical ablation without any adjuvant therapy and it should be considered in the differential diagnosis of urethral tumors.

PP29-11
Early experience of laparoscopic radical prostatectomy for pT3 prostate cancer: singleinstitution retrospective study Changmin Im 1 , Euchang Hwang 1 , Sungil Jung 1 , Taekwon Kang 1 , Dongdeuk Kwon 1 , Kwangsung Park 1 1 The department of urology, Chonnam national university medical school (Republic of Korea) Purpose: The treatment for locally advanced prostate cancer is still controversial. The surgical approach has often been discouraged because of surgical technique, possibility of incomplete tumor removal, distant or local metastasis. We evaluated results of surgical outcomes in patients with pT3 prostate cancer treated with laparoscopic radical prostatectomy (LRP).

Materials and methods:
A total of 120 patients who performed LRP for cT1c or cT2 prostate cancer between Jan 2006 and May 2009 were enrolled. The patients were divided into 2 groups according to postoperative pathologic stage: localized group (pT2, group I, n=85) and locally advanced group (pT3, group II, n=35). We compared to the perioperative parameters and early surgical outcomes between 2 groups.

Conclusion:
The early surgical outcomes of laparoscopic radical prostatectomy for locally advanced prostate cancer was not different significantly compared to those of localized prostate cancer. We consider that laparoscopic radical prostatectomy may be a reasonable treatment option for locally advanced prostate cancer.

PP29-12
The effects of computerized case management of patients with abnormal serum prostate specific antigen Fang-Shu Lin 1 , Yevvon Chen 1 , Juo-Yun Lee 1 1 Information management Mennonite Christian Hospital (Taiwan) Purpose: The study investigates that computerized case management of patients with abnormal serum prostate specific antigen(PSA) level could make the difference of the numbers of follow-up-patient visits.

Methods:
We retrospectively compared with number of follow-up visit present by himself,follow-up visit present by phone call and lost follow-up visit from the time of initial abnormal PSA findings ( 10ng/ml).
Results: Numbers of patient with follow-up visit by himself within 3months e.g. April, May and June 2009 are sixteen of 27(59%), twenty-one of 31(68%) and twenty-six of 36(72%), respectively With computerized management system(instructor with usage of internet), the total number of follow-up visit present by phone call become twentytwo of 27(81%), twenty-five(81%) and thirty-five of 36(97%)respectively.

Conclusion:
Computerized case management can only be applied by health education instructor working well with internet-system. Thus, this study suggested that the computerized case management model could be promoted to increase relative ratio of follow-up visits.

PP29-13
Influence of cytokine gene polymorphisms on prostate specific antigen recurrence in prostate cancer after radical prostatectomy Purpose: Evidence is accumulating indicating that chronic inflammation plays an important role in prostate cancer. We investigated the potential prognostic roles of IL-6, IL-8 and IL-10 polymorphisms in clinical localized prostate cancer after radical prostatectomy.

Materials and Methods:
A total of 116 clinically localized prostate cancer patients undergoing curative radical prostatectomy were included in this study. The IL-6, IL-8 and IL-10 polymorphisms were determined by the TaqMan real-time PCR method. Their prognostic significance on prostate-specific antigen (PSA) recurrence was assessed using Kaplan-Meier analysis and Cox regression model.

Results:
The IL-6 polymorphism (rs2066992) T/G and G/G genotype cases were associated with a higher percentage of preoperative PSA levels of>or=10ng/ml; higher risk of positive surgical margin, and higher risk of extraprostatic extension compared to the T/T genotype. The IL-10 polymorphism (rs1800871) A/A genotype was associated with a higher risk of PSA recurrence compared with the A/G + G/G genotypes and significantly poorer PSA-free survival (log-rank test, p=0.019). After considering other covariates in a Cox proportional hazard model, the IL-10A/A genotype and high Gleason score (8-10) were still independent predictors of poor PSA-free survival.

C o n c l u s i o n :
O u r r e s u l t s s u g g e s t t h a t t h e I L -1 0 polymorphism may be a prognostic factor for PSA recurrence after radical prostatectomy.

PP29-14
Alternative bladder cancer therapy: laser transurethral resection of bladder tumor combination with adjuvant radiation therapy Hung-Jen Shih 1 , Chin-Pao Chang 1 1 Department of Urology, Changhua Christian Hospital (Taiwan) Purpose: We used diolaser for transurethral resection and fulguration bladder tumor combination with adjuvant radiotherapy as the alternative treatment procedure for the tumors difficulty treated with traditional cutting loop.
Case report: Two patients were treated transurethrally with Diolaser. One patient presented with a large intradiverticular tumor in the right lateral bladder wall near ureteral orifice. Patient refused the radical cystectomy and partial cystectomy is not indicated due to near the ureteral orifice. Traditional cutting loop can not reach the tumor site accurately. We used the Diolaser for fulgurated with tumor as much as possible and only small residual mass was noted after fulguration. Then the patient received the adjuvant radiothepray and no tumor recurrent for 1 year. Another patient presented with a large tumor occupied in the whole right bladder wall. The patient refused the radical cystectomy due to old age and poor general condition. We used the Diolaser to cutting the tumor first then fulgurated with tumor base as much as possible. After he received the radiotherapy, no tumor recurrence was noted for 6 months.

Conclusion:
Laser therapy can removed more tumor lesion if the tumor is located on the difficulty approach sites. If combined radiation therapy as an adjuvant therapy, some small residual tumor can be treated more precisely. Transurethral resection of bladder tumor with Diolaser combination with adjuvant radiotherapy can be used as an alternative treatment procedure for the bladder cancer.

PP29-15
Clinical significance of runtrelated transcription factor 1 polymorphism in prostate cancer  Ureteroscopic biopsy in differential diagnosis of ureter narrowing: value and pitfall Purpose: To discuss the value and pitfall of endoscopic biopsy via retrograde ureteroscopy in differential diagnosis of benign and malignant ureteral narrowing.
Results: Among the 23 cases, 15 were diagnosed uTCC and 8 benign ureteral narrowing. Of the 15 uTCC, 6 were diagnosed based on computed tomography and/or magnetic resonance imaging and 9 on biopsy through ureteroscopy. Among these 9 cases, 2 were proved malignance by frozen section during inspectional surgery following negative ureteroscopic biopsy. Of the 8 benign ureteral narrowing, 6 were diagnosed through ureteroscopy and 2 based on radiography.
Conclusion: Ureteroscopic biopsy has important value in differential diagnosis between benign and malignant ureteral narrowing. For some intrinsic limitations, however, possibility of false negative results exists at certain circumstances. Therefore, if clinical features other than biopsy are highly suspicious for a malignant diagnosis, an inspectional surgery is warranted despite of negative biopsy result.

PP29-17
A prospective study of significance of haematuria in University Malaya Medical Centre Purpose: To analyse the causes and significance of adults presenting with haematuria and to determine the incidence of bladder tumours in these patients.

Materials and methods:
During the prospective twelve month period from April 2009 till March 2010, all consecutive patients with confirmed haematuria were enrolled in this study. These patients were subjected to a variety of imaging techniques and mandatory flexible cystoscopies at the nearest possible dates. Clinical characteristics together with the imaging results, cystoscopy findings and final diagnoses were recorded and analysed.
Results: There were 160 consecutive patients with haematuria investigated comprising 109 cases of microscopic haematuria and 51 cases of macroscopic haematuria. Age range was from 19 till 93 years old (mean 57 years) with almost equal contribution from 83 females and 77 males. Various ethnic groups were seen with 78 Chinese patients, 51 Malays, 27 Indians and 4 other minority races. The final diagnoses of haematuria were no cause found (35.6%), cystitis (21.9%), prostatomegaly (13.1%), urolithiasis (11.3%), urinary tract infection (5.6%), bladder tumour ( 5%), renal cortical cysts (3.8%), prostate cancer (0.6%), renal tumour ( 0.6%) and other causes (2.5%). There were 8 new cases of bladder tumours with one renal tumour and one prostate cancer diagnosed in these patients. All of the bladder tumour patients diagnosed were above 50 years old with 5 patients presented with microscopic haematuria and 3 from the macroscopic group. The histology of these bladder tumours revealed transitional cell carcinoma and there were no significant risks associations (eg smoking, dye exposure, pelvic irradiation) established in this small study. Majority of the patients were diagnosed within 4 weeks and most had visited one doctor prior to being investigated at our urology centre.

PP29-18
Metastatic cervical lymph node compressing on subclavian vein-a rare presentation of metastatic renal cell carcinoma KL  Renal cell carcinoma is the most common malignant neoplasm of the kidney accounting for about 3% of adult malignancies. Nevertheless it often has an insidious presentation with the classical triad of haematuria, flank mass and loin pain being uncommon presentations and usually indicative of more advanced disease. With its background of variable clinical presentations, unpredictable growth rates and timing of metastases, renal cell carcinomas are often notorious with metastases in 20-25% of patients at presentation. However, solitary head and neck metastases arising from renal cell carcinomas without evidence of disease elsewhere are rare. We report a rare case of renal cell carcinoma presenting initially only as a rapidly growing right cervical lymph node compressing on subclavian vein. Urgent biopsy of the neck mass revealed metastatic clear cell carcinoma with subsequent computed tomography scan revealing a small left upper pole renal tumour with metastatic right cervical lymph node compressing on the subclavian vein leading to bilateral pulmonary embolism and right upper limb swelling. The patient was then given radiotherapy to neck mass and was started on anticoagulant therapy for treatment of pulmonary embolism; following which molecular targeted therapy for the metastatic renal tumour was initiated appropriately.

Conclusion:
This prospective study highlighted the common causes of both microscopic and macroscopic haematuria in our hospital. The incidence of bladder tumour in this study was 5% with all patients being above 50 years old. We recommend that full and appropriate urological investigations be carried out in all patients with haematuria especially elderly patients in hope of providing early detection and management of bladder tumours.
herpes zoster was made as diagnosis. Because the symptom did not improved, patient visited our dermatology, where skin biopsy showed extramammary Paget s disease. Left lower neck area found small nodule, biopsy suspect adenocarcinoma. Patient received topical 5-Fu for skin lesion and systemic chemotherapy. The second case is 45 years old, found left scrotal itching for one year, tinea infection was made as diagnosis at other hospital, but the discomfort did not subside. Patient received skin biopsy at our dermatologic outpatient department, confirmed extramammary Paget s disease, and received wide excision with primary closure. The third case is 70 years old, bothered from penis lesion with fluid discharged. Patient visited our urologic outpatient department, where skin biopsy showed extramammary Paget s disease. Patient received wide excision with local pedicle myocutaneous flap reconstruction.

Results:
No mortality, no local recurrence is noted within these three patient.
Conclusion: Extramammary Paget s disease can express the same characteristics with other skin lesions, like eczema, dermal infection and other dermatitis. Diagnosis usually is confirmed by lesion biopsy. Wide excision is the treatment of choice for noninvasive extramammary Paget s disease. Medical treatment including 5-Fu, Imiquimod and the combination of trastuzumab and paclitaxel. Surgical treatment includes wide excision. Other therapeutic methods such as radiotherapy and photodynamic therapy also can be used.

PP29-20
Trocar puncture wound extravasation with acute abdomen: a rare perioperative complication of transurethral resection of the prostate Purpose: Through many new techniques were advanced for operation of benign prostatic hyperplasia (BPH), transurethral resection of the prostate(TURP) remains the gold standard in the surgical indication of these patients. We describe a patient who underwent TURP with suprapubic cystostomy and developed urine and fluid extravasation via puncture wound of bladder. The irrigating fluids extended from perivesical tissue into intraperitoneum.

Materials and methods:
A 60-year-old man had a history of COPD. He was arranged for TURP resection due to acute urinary retention. Suprapubic cystostomy was performed for continuous irrigation with distilled water. During a period of 90min, 58gm of prostatic tissue was resected with 550ml blood loss. The cystostomy tube was removed under gauze coverage. However, he felt abdominal pain and dyspnea on the morning of the second postoperative day. Emergent abdominal computerized tomography (CT), cystography were arranged, UB rupture with extraperitoneal urine/air collection and intraperitoneal fluid accumulation were found. He underwent laparoscopic exploration of abdomen. Much amount of serous, urine-like ascites about 2000ml was drawn by suction tube. There was neither perforation hole nearby bladder nor bowel injury after careful examination. We performed open suprapubic cystostomy at previous trocar wound. A small hole and eversion of bladder mucosa at extraperitoneal space with large amount of fluid extravasation was found. No blood clot retention but an unsealed puncture wound was found under cystoscopy.
Results: Trace the patient s history, he had LUTS for 5 years and increased bladder capacity (>1000ml) due to chronic urinary retention. The bladder wall was very thin with severe trabeculation. After removal of cystostomy tube, the bladder mucosa everted without sealing, which provide a gateway for irrigating fluid entrance. Furthermore, the Foley catheter may be partially obstruction by bladder mucosa and urothelial debris. Although the Foley catheter was inserted, fluid and urine pass partially through bladder into peritoneum under high pressure irrigating fluid. The fluid dissected perivesical tissue gradually through retroperitoneum into the weakest point of peritoneum. The peritoneum ruptured, abundant amount fluid accumulation in the abdomen as the result of abdominal distention and dyspnea.
Conclusion: Acute abdomen represents a rapid onset of severe symptoms that related by a variety of life-threatening pathological conditions. Most causes need surgical intervention. We present the first case of acute abdomen that induced by trocar puncture wound extravasation. This rare complication of post-TURP surgery was dangerous and should be treated urgently.

PP29-21
Comparing PSA & free PSA serum levels in fresh and freezed blood Rahim Taghavi 1 , Reza Mahdavi 1 , Mohammad Reza Darabi Mahboub 1 1 Department of Urology, Imam Reza Hospital (Republic of Iran) Purpose: PSA (prostate specific antigen) is a paragon for evaluation of prostate adenocarcinoma. In many industrial countries this antigen has been assayed immediately after sampling and the scale of it has been evaluated. But in many laboratorles of our county the sample has been freezed for a long period about 72 to 96 hour or more in the freezer that the temperature isn't constant and usually is about-20 to-30℃, and after this period it is evaluated.It seems that this way of freezing for the laboratory sample for the reason of long term preservation, regard to 1-structure of PSA, 2-period of sample preservation, 3-value of freezing and, 4-way of preservation in our laboratories can effect on the scale of the sampelling in the fresh and freezed PSA plasma. By the way, this study perform for the reason of effects of freezing & way of preservation in laboratories of our country survey on the scale of total & free PSA in the fresh & freezed plasma. Materials and methods: 110 Patient's with LUTS symptom that have been refered to the urology clinic from Nov 2008 to May 2009 are elected and refered to laboratory for four sampling: two sample for each laboratory that in each laboratory one sample has been freezed and evaluated after 72 hour and the other sample immediately evaluated and then the results were compared with each other.

Study of p53 and heat shock protein (HSP) manifestations in bladder cancer
Seok Heun Jang 1 , Jae Il Kim 1 , Jeong Hwan Son 1 1 Bundang Jesaeng General Hospital (Taiwan) Purpose: The mutation of p53 gene can be observed in almost every kinds of tumor, and is known to have prognostic implication in the management of the bladder tumor. Also, the production of Heat shock protein stimulated by physiologic and environmental stress, and manifested in various tumors in human. Its role in the prognosis of various tumors has been studied extensively, but not much has been revealed of its role in the bladder tumor. We studied the manifestations of HSP in bladder tumor to elucidate the relationship between the p53 gene and the tumor stage and grade of differentiation.

Materials and methods:
The manifestations of HSP were analyzed using immunohistochemistry staining and Western blot, and that of p53 using immunohistochemistry staining in pathologically proven 28 cases of bladder tumor.
Results: 1) In 13 cases of superficial bladder tumor, p53 and HSP were positive in 6 cases(46.2%) respectively, and in 15 cases of invasive bladder tumor, they were positive in 7 cases(46.7%) and 9 cases(60.0%) respectively, not having any significant relationship with the tumor A303 stage(p>0.05). 2) As for the grade of differentiation, in 11 cases of grade 1 tumor, p53 and HSP were positive in 5 cases(45.5%) and 6 cases(54.5%) respectively. In 9 cases of grade 2 tumors, p53 and HSP were positive in 4 cases(44.4%) and 5 cases(55.6%), and as for the 8 grade 3 cases, 4 cases(50.0%) and 4 cases(50.0%) respectively. No significant difference was noticed according to the differentiations of tumor(p>0.05).

Conclusion:
The manifestations of p53 and HSP had no significant correlation with the tumor stage and grade of differentiation in bladder tumor, but p53 and HSP appear to have significant correlation between each other, and should be studied further by means of molecular biology.

PP29-23
Organ preserving surgery in benign intratesticular tumor Keratinized epithelium interspersed with the connective tissue may give this lesion the classic"onion-peel" configuration on ultrasound.Epidermoid cysts range in diameter form 1 cm to 3 cm.The patient age is variable but usually ranges from 20 to 40 years.The ultrasonography appearance varies with the maturation, compactness, and quantity of keratin present within the epidermoid cyst.The clinical course of this case will be reported and literature will be reviewed.

PP29-24
Nursing experience of taking care of a mental retard patient with end stage renal disease under hemodialysis and tansitional cell carcinoma of urinary bladder Li-pin Chiu 1 , Pao-Chun Lai 1 , Lei-Lan Wu 1 , Shiou-Sheng Chen 1 1 Division of Urology, Department of Surgery and Nursing,

Taipei City Hospital Renai Branch (Taiwan)
We reported our nursing experience of taking care of a mental retard patient with end sage renal disease (ESRD) under hemodialysis (HD) and transitional cell carcinoma (TCC) of urinary bladder (UB). The follow-up is from Aug 24, 2009 to 27 Aug, 2009. We use eleven healthy function status of Gordon to evaluate this patient through interviewing, observing, and listening. We collected the data and find the major healthy problems of the patient including: (1) Anxiety and fear of receiving operation and entering into operation room without company, (2) pain after operation, (3) the nervousness of his family. All these problems were related to poor communication with the patient, who had mental retard and had TCC of UB. During the process of nursing care, we built a nursepatient relationship, listened to the patient and encouraged the patient to express the feeling by himself. In addition, with the support from his family, we do our best to let the patient understand the surgical procedure, and transfer the feeling of fear and anxiety by enjoying the music, which would dilute the tension of nervousness and he could overcome the discomfort after operation. After operation, we used pain control skill to decrease the pain score from 9 to 1. Besides, we provided the surgery-related information and our successful nursing experience of similar cases to encourage his family to raise their questions and to understand the whole procedure in order to reduce the nervousness of patient and his family. We reported our nursing experience of taking care of a mental retard patient with ERSD under HD and having TCC of UB, who received transurethral resection of bladder tumor (TURBT). From this case, we realized the team work and adequate medical and nursing care are important for such patient.

PP29-25
Relationship between prostate specific antigen and obesity: analysis of a large cohort of Toyota Motor Corporation employees

Results:
The percentage of men with BMI>30 in this cohort was low at 2%. PSA level decreased significantly with increasing BMI, but the coefficient of determination was very low. Age was more strongly correlated with PSA level than was BMI. Mean PSA values decreased from 1.02 to 0.85 ng/mL as BMI increased from underweight (BMI <18.5) to morbidly obese (BMI >35). However, PSA mass peaked in the overweight category and reduced slightly with increasing BMI. On multiple regression analysis, PSA level was influenced by age, diastolic blood pressure, and high-density lipoprotein as well as BMI.
Conclusion: An inverse but weak relationship between PSA level and BMI was found in this population of Japanese men. In Japan the prevalence of obesity is low and the influence of obesity on prostate cancer screening appears very limited. Accordingly, no adjustment of PSA threshold in obese men appears necessary in prostate cancer screening in Japanese men.

Conclusion:
The results of our study have shown that measurement of urine NMP22 is a noninvasive, highly sensitive and specific method for detecting UCB in Chinese population. Further studies can be helpful to determine whether it can be used to reduce the frequency of cystoscopy at a reasonable risk.

PP29-28
The prelininary results of docetaxel-prednisolone plus hormon combination therapy in the treatment of patient with hormone-refractory prostate cancer We retrospectively surveyed the incidence, characters, immunosuppressant and treatment out come in these patients.

Materials and methods: Between Aug 2007 and
Mar 2009, totally one hundred and forty-seven kidney transplants were enrolled where 89 stable renal function and 58 with acute episode were included. Philip HDI 5000 was used to evaluate renal cortex perfusion with power Doppler function. The images of vascular tree included interlobar, arcuate and interlobular vessels among different site of cortex and at least 3 cardiac cycles were recorded. Data also included several resistance index at different interlobar vessels. Clinical parameters included serum creatinine, age, sex and body weight. Power Doppler vascular index (PDVI) was defined as the percentage of color pixel in the region of interest (ROI). Renal Vascularity Index Quantification software was used for analysis, which was designed by Angiogenesis Research Center, National Taiwan University.

Results:
The RVPI have significant correlation with estimated creatinine clearance including Cockcroft-Gault formula and Modification of Diet in Renal Disease (MDRD). In stable group, cases were categorized into three groups with different renal function (Cre 1.5 , 1.5-2.5 A309 and 2.5mg/dL, n=60, 22 and 7 respectively) , significant difference is noted between three groups(p= 0.04). In acute episode groups, between three groups, there are significant difference (p=0.00) with cases number 18, 23 and 17 respectively. In five cases with series evaluation, RPVI level is higher in acute episode (acute rejection) and turn down after treatment of acute rejection. In one case with acute humoral rejection, RVPI method is also used as a coevaluate method to predict graft recovery.
Conclusion: This new model has proved its utility for renal function evaluation and correlated with acute episode among renal allograft patients. To our knowledge, this is the first model using non-invasive US examination to examine renal perfusion validly.

PP29-34
Rituximab and early plasmaphoresis in highly sensitive transplantation Purpose: Few options for transplantation currently exist for patients highly sensitized to HLA in cadaveric transplantation. Those transplantations will exist higher chance of acute humoral rejection early after transplantation. Some protocol demonstrate effectiveness of high dose intravenous immune globulin plus rituximab that can reduce anti-HLA antibody levels and improve transplantation rates (NEJM 2008:359;3). However, costeffective is a major concern in this protocol. We would like to demonstrate our experience of using rituximab plus plasmaphoresis soon after transplantation in case with PRA 91%.

Materials and methods:
A 49 year old male accepted cadaveric kidney transplantation on Oct.10 2009. He has accepted CAPD since Mar 2007 with diagnosis of glomerulonephritis. He was highly sensitized patient with PRA 91% with history of transfusion. No DSA data available before transplantation. Crossmatch is negative. Before transfusion, he refused induction protocol of rituximab plus high IVIG protocol (2g per kilogram of body weight on day 0 and day 30) since more than one million NT dolor is unbearable. We introduced another option of rituximab 500mg (50K NT) plus early plasmaphoresis (17k NT each) for him.
Results: Plasmaphoresis was proceeded on D2, D4 and D6 and serum creatinine recovery well from 15mg/dL to 2.7mg/dL at 7th day. However, creatinine rebounded at 8th day to 3.2 and we added rescued plasmaphoresis course at 8th to 13rd day that creatinine ceils at eleven day with 5.4. Since creatinine went down again, no more plasmaphoresis introduced after 13rd day. Once hemodialysis was introduced for fluid overload at 12nd day. This acute humoral rejection was proved at day 10 (Monday). Now his creatinine is stable at 1.3mg/dL with CNI combined MMF and steroid maintenance protocol.

Conclusion:
He accepted once 500mg rituximab and 9 plasmaphoresis that costed NT 203K with good result. However, we need more experience and laboratory data (HLA Ab title) to prove the effectiveness and benefit of early plasmaphoresis and randomized study. As compare to another case without preparation, she lost her allograft with AHR at 3rd day. We recommend this protocol is much cheaper than protocol with rituximab plus IVIG with good result at high sensitized cadaveric transplantation.

PP29-35
Case report The use of antilymphocyte antibody induction therapy continues to be widespread and is slowly increasing. Overall, almost 80% of patients are given one of the following medications: Rabbit ATG (42%), basiliximab (18%), daclizumab (11%), or alemtuzumab (10%). Four agents have been studied in combination with varying immunosuppressive regiments on patients of varying immunosuppressive regimens on patients of varying immunologic risk. This study was designed to compare the efficacy of induction of basiliximab between Asian and others. The other objection is sharing our experiences in use of basiliximab.

PP29-36
The utility of extended criteria donors: early to start! Purpose: The renal transplantation program has been started since 2004 in our hospital. Like the universal problem, the waiting list has grown and the discrepancy between demand and supply has increased in our hospital even we joined the Taiwan Organ Registry and Sharing Center (TORSC). In addition, non-optimal donors were also harvested beyond our institute after joining the TORSC. We report our limited experiences about the utility of extended criteria donors (ECD) and encourage colleagues early to start it. Conclusion: Extended criteria donors can be feasible used for renal transplantation if the recipients and their family well known both the risks and benefits with fully appropriate consent documentation. Method like the Karpinski 12-point scale can be used to facilitate optimal organ selection. Improving the method for graft transporting and the ability of immunosuppressants adjustment will improve the outcome.

PP29-37
Ectopic ureter in childhood-NCKUH's experience Hong-Lin Cheng 1 , Yuan-Yow Chiou 1 1 Medical College and Hospital, National Cheng Kung University (Taiwan) Purpose: Ectopic ureter, defined as ureter draining into instead of urinary bladder but other organs such as vagina or urethra, is not a common disease in childhood. It contributed to the major cause of urinary incontinence induced by anatomical abnormality in childhood. In this paper, we present our experience in the management of ectopic ureter in childhood.

Materials and methods:
A total of 5 cases of ectopic ureter is collected in recent 15 years including 4 female and 1 male. The age of diagnosis is 1 month, 2.25 years, 6.5 years, 6.5 years, and 14.3 years. One case is duplicated A311 system and 4 cases are single system. CT scan, DMSA and cystoscopy are the key diagnostic tool.

Results:
The presentations and associated symptoms/signs are urinary incontinence in 3 cases, renal agenesis in 1, duplicated kidney in 1, ectopic kidney in 1, and prenatal hydronephrosis in 1. Nephrectomy in 1 case, partial nephrouretectomy in 1, ureteral reimplantation in 2, and close observationin 1 are conducted. For the indication of urinary incontinence, it is subsided totally.

Conclusion:
Although the incidence of ectopic ureter is rare, it plays a major role in urinary incontinence in childhood. After definite treatment, the symptoms subsided dramatically.

Transurethral endoscopic incision (TUI) in the treatment of infant with ureterocele.
Hong-Lin Cheng 1 , Yean-Yiou Chiou 1 1 Departments of Urology and Pediatrics, Medical College and Hospital, National Cheng Kung University (Taiwan) Purpose: Ureterocele, defined as abnormal dilation of ureter in the bladder wall, usually occurs in duplicated kidney and results in renal function impairment of this moiety. In this paper, we report our experience in the treatment of infant with ureterocele using TUI.

Materials and methods:
We retrospectively reviewed the medical records of 11 patients (12 renal units) who admitted to this hospital for treatment of ureterocele in the last 15 years. There were 11 infant, 9 female and 2 male, with age ranged from 1 month to 5 months (mean 3.2 months), and 7 in duplicated system and 4 (5 renal units) in single system. TUI were performed for the first aid.
Results: In the duplicated system group, 3 patients underwent ureterocele excision and ipsilateral ureteral reimplantation for severe UV reflux, prominent residual ureterocele and urinary tract infection further, while 3 in 4 patients with TUI only had mild UV reflux. In the single system group, 1 with renal agenesis underwent excision of ureterocele and 3 (4 renal units) were ureterocele subsided.

Conclusion:
In duplicated system group, after finishing initial TUI procedure, 6 in 7 patients had complications residual. In contrast to the single system group, 1 in 4 patients needed further management.

PP29-39
Large voided volume suggestive of abnormal uroflow pattern or elevated post-void residual urine in healthy kindergarteners Shang-Jen Chang 1,2 , Stephen Shei-Dei Yan 1,2 1 Division of Urology, Buddhist Tzu Chi Hospital (Taiwan) 2 School of Medicine, Buddhist Tzu Chi University (Taiwan) Purpose: To report the cutoff value for Large Voided Volume suggestive of abnormal uroflow pattern or elevated post-void residual urine (PVR) in healthy kindergarteners.

Materials and Methods: From 2003 through 2008, 417
healthy kindergarten children were enrolled for evaluation of uroflowmetry tests and PVR. The uroflowmetry curves were interpreted if voided volume (VV) were >50 ml, and categorized as bell-shaped, staccato, plateau, and interrupted. Only bell-shaped curves were categorized as normal. After 2006, PVR was assessed within 5 minutes after each voiding with a VV >50 ml. A PVR >20ml is regarded as elevated. Receiver operative characteristic (ROC) curves were constructed to evaluate the cutoff value of voided volume/expected bladder capacity (EBC) with regard to nonbell-shaped uroflowmetry curves, and/or elevated PVR.
Conclusion: Voided volume of more than 100% EBC can be defined as Large Voided Volume which was associated with high rates o f abnormal uroflow pattern and elevated PVR.

PP29-40
The surgical outcomes of minilaparoscopic herniorrhaphy in infants

Materials and methods:
We enrolled 51 infants undergoing herniorrhaphy. Mean ages of the 23 MLH and 28 OH were 7.17±4.21 and 5.39±4.11 months old, respectively (p=0.367). A contralateral patent processus vaginalis 2 cm noted laparoscopically was repaired simultaneously in 13 (68.4%) of 19 infants who clinically presented as unilateral hernia. Finally, 17 and 6 infants had bilateral and unilateral MLH, and 8 and 20 infants had bilateral and unilateral OH.

Results:
The mean follow-up periods in MLH and OH groups were 22.9±10.5, and 20.2±10.5 months, respectively (p=0.20). Contralateral metachronous inguinal hernia (CMIH) occurred in 4 (19%) of the 21 unilateral hernia in OH Group, and in zero of the 19 initially presented unilateral hernia in MLH group. The three CMIH were subsequently repaired by open methods. Recurrence occurred in 1 of 36 OH sites, and none of 40 of MLH sites (p= 0.47). The mean operation time of the unilateral herniorraphy was statistically longer in the MLH Group than that in the OH Group (80.00±18.97 vs. 51.15±23.27 minutes, p=0.049). The mean operation time of bilateral repair was comparable between MLH and OH groups (82.52±14.74 vs. 95.62±20.62 minutes, p=0.35).

Conclusion:
Mini-laparoscopic herniorraphy in infants resulted in a trend of lower rate of CMIH and was as effective and safe as open herniorrhaphy. The drawback of mini-laparoscopic repair was the longer operation time, which may be overcome by increasing experience.

Laparoscopic upper pole hemiphrectomy and ureterectomy for infants with complicated non-functional upper pole moiety of duplex kidney
Chi-Fai Kan 1 , Kim-Chung To 1 , Ming-Kwong Yiu 1 1 Princess Margaret Hospital (Hong Kong) Purpose: To review the presentation of two infants with complicated non-functional upper pole moiety of duplex kidney and to review the related laparoscopic technique and short term result.

Materials and methods:
Two cases paediatric patients with recurrent infection of the non-function upper pole moiety of duplex kidney had laparoscopic upper pole heminephrectomy and ureterectomy down to common ureteric sheath done. Case history and the operative approach were retrospectively reviewed.
Results: One 14-month old and another 11-month old baby were presented as antenatal hydronephrosis. MAG3 scan showed non-functional left upper pole moiety nonfunction kidney. They had recurrent urinary infection(UTI) requiring laparoscopic upper pole heminephrectomy and ureterectomy down to common ureteric sheath. During the operation, the patient was lying at left lateral 45 degree oblique position. A 5mm port was inserted to left lower quadrant by open method. Two 5mm ports and one 3.5mm port were inserted. Left colon was mobilized. The dilated and tortuous upper moiety was dissected from the lower moiety ureter and was transected at the level of renal pedicle. The lower pole moiety renal pedicle was isolated. The upper moiety ureter was transpositioned to above the pedicle. The proximal remaining upper pole moiety and ureter were further dissected from the lower moiety and the A313 upper pole vessels were cauterized with harmonic scalpel and clips. The distal upper moiety ureter was transected down to the common ureteric sheath and with the stump plicated with vicryl stitches. The specimen was retrieved through a plastic glove from the 5mm port. A tubal drain was inserted to the renal bed. The body weight of the two patients were 10.8kg and 7.6kg respectively. The operative time was 240min and 215min and the blood loss was 50ml and minimal respectively. There was no complication in both operations. No transfusion was required. They could resume oral feeding in post-operative day 2. Tubal drains were removed from day 5 and day 2 respectively. They were discharged Day 5 and Day 3 post-operatively. They remained well on follow up in 14 months and 10 months respectively after operation without recurrence of UTI.

Conclusion:
Laparoscopic upper pole heminephrectomy and ureterectomy down to common ureteric sheath is a feasible and safe approach for paediatric patients with nonfunction upper pole moiety duplex kidney.

PP29-42
Hypospadias with a hypoplastic urethra Jesun Lin 1 , Heng-Chieh Chiang 1 , Bai-Fu Wang 1 , Chin-Pao Chang 1 , Ming-Chih Chou 1 1 Department of Urology, Changhua Christian Hospital Institute of Medicine, Chung (Taiwan) Purpose: Hypospadias is characterized by a ventral triangular defect by the variable length of the urethra, division of the corpus spongiosum and the ventral skin. Hypospadias with a hypoplastic urethra is a special event of hypospadias that the distal urethra is not surrounded by corpus spongiosum but only ventral skin. There are two aims of this study: (1) to describe the technique of reconstruction and (2) to evaluate the feasibility of the preservation of the hypoplastic urethra in reconstruction for the hypospadias with hypoplastic urethra.

Materials and methods:
This is a retrospectively clinical description. We had 28 cases of the hypospadias with a hypoplastc urethra in the total 326 hypospadias patients from January 1999 to January 2009. The operation methods include: (1) 10 cases were performed by sacrificing the hypoplastic urethra and then urethroplasty. (2) 18 cases were preserved the hypoplastic urethra. We peeled or polished off the epithelial layer with scissor or gauze, after injecting 1:100,000 epinephrine in the subepithelial space of hypoplastic urethra. We preserved the hypoplastic urethra and then performed the urethroplasty.

Result:
There are three cases of post operation fistulae in the group of ten cases which were repaired by sacrificing the hypoplastic urethra. The eighteen cases were repaired with preserving the hypoplastic urethra is uneventful.

Discussion:
The preservation of the segment of the hypoplastic urethra could be feasible in reconstruction of this specific type of hypospadias with none or minimal chordee. If the chordee is severe, or the hypoplastic urethra is too short to be preserved, it is preferred to sacrifice the hypoplastic urethra for urethroplasty and orthoplasty.

Conclusion:
Preservation of the hypoplastic urethra is a feasible method of reconstruction for hypospadias with hypoplastic urethra. This method might shorten the operation time, lessen the complication and make the operation easie.

PP29-43
Long-term followup of children with vesicoureteral reflux treated by endoscopic injection of dextranomer/hyaluronic acid copolymer Purpose: The purpose of this retrospective study was to evaluate the efficiency of subureteral injection type in patients with midlle-high grade reflux (VUR).

Materials and methods:
In the period between June 1999 and September 2008, 149 patients and 213 ureteral units with primary VUR were injected with Subureteral Dextronomer. The patients were divided into two groups: those who were treated by the standard method and those who received the modified method, i.e. within the ureteral tunnel. The patients who were unsuccessful after the first injection were given a second or even a third injection. Those who were unsuccessful were directed to open surgery. Group1 consisted of 54 patients (44 females and 10 males) and 79 ureteral units while Group2 included 95 patients (68 females and 27 males) and 134 ureteral units. The median age for Group1 was 7.82 (ranging from 18 months to 144 months) whereas the median age for Group2 was 6 (ranging from 2 months to 18 years old). The mean follow-up was 12 months (ranging from 6 to 24 months). Post-surgery was evaluated by cystography on the third month. Results: After a single injection refluxing unit of 48 out of 79 from Group1 and 86 out of 134 from Group2 were completely resolved. After the second and third injections, the overall success was 58/79 (73.4%) for Group1, and 108/134(80.5%) for Group2. Chi-Square test was used in the statistical evaluation of the groups. No statistical differences were observed between the total recoveries in both groups. Patients with Gr 2 reflux was resolved completely in both groups. In hıgh grade reflux modified sting procedure was found more successful in our patient While in lower grade reflux there were no significant differences between 2 methods. Results are shown in table 1.

Conclusion:
Endoscopic treatment of vesicoureteral reflux has been the first choice among the patients owing to the fact that this method is the least invasive, most effective and can be repeated. It was observed that although there was no significant difference between the two methods among patients suffering from lower grades of reflux (grades 2 and 3), the modified sting procedure worked more efficiently for those with higher grades of reflux. As a result, we conclude that the modified sting procedure through intramural ureter constitutes a good alternative to the standard method.

Predisposing factores in symptomatic urinary tract infections in children
Faramarz Fazeli 1 , Simin Sadeghi Bojd 1 , Alireza Amra Shestan 1 , Anoosh Naghavi 2 1 Ali-ebn-abitaleb hospital, Zahedan university of medical sciences, Zahedan (Iran) 2 Cellular and molecular research center. Zahedan University of medical sciences -Zahedan (Iran) Purpose: Urinary tract infection (UTI) is one of the most common infectious diseases in children with several predisposing factors. The aim of this study is to determine the predisposing factors of symptomatic UTI in 3 months to 10 years old children, reffered to the pediatric clinic in our hospital.

Materials and methods:
This cross sectional study was done on 140 children 3months to 10years old (66 female 74.2% and 23male 25.8%)with UTI, documented by urine culture, ultrasonography and voiding cyctourethrography, who admitted In hospital during 6 month, (mar. to sep. 2008).
Conclusion: 1-We suggest urodynadimac studies in patients with normal radiological findings and recurrent infections or urinary -intestinal symptoms. 2-Regarding the importance of VUR in children smaller than 5 years, complementary radiologic surveys should be done. 3-Establishment of training courses for the province doctors and emphasis on diagnosis importance of predisposing factor. 4-Emphasis on sonarography importance during pregnancy for diagnosis obstructive uropathy. 5-circumcision during first year of life in boys.
with Pentoxifylline for undescended testis.

Materials and methods:
We enrolled a total of 33 undescended testis patients with 53 testes, 36 retractile and 17 true undescended testes. All the children had received the operation of orchiopexy done by same surgeon. The children s age range was from 10 months old to 12 years old with the mean age of 6.3 years old. The postoperative followup with the instrutment of ultrasound had done at every 3 months interval. The 18 children had received the postoperative medical therapy with Pentoxifylline for three months, and not done other 15 patients. The postoperative followup was from 6 months to 6 years.

Results:
The results of long-term followup for the children with undescended testis s/p orchiopexy revealed the different testis ratio between the two groups, received the postoperative medical therapy with Pentoxifylline or not. The former showed the data of 0.80±0.05, the latter 0.62± 0.04.

Conclusion:
This miniature report showed the valid principle of the postoperative medical therapy with Pentoxifylline as the accelerant for the growth of orchiopexy testis. However, the endocrine and pathologic factors should be further investigated. 18 36; 2 4; 13 13

Ming University (Taiwan)
Introduction: Ureteral endometriosis is rare and it can cause to renal failure due to asymptomatic obstruction of the ureter. It is difficult for early detection. Herein we presented a rare case with left upper third ureteral polypoid endometriosis causing nonfunction kidney.
Case report: A 49-year-old female patient had history of diabetes mellitus and hypertension and presented as intermittent right flank dull pain and fever for several years. Urine routine showed pyuria. Renal echo showed right severe hydronephrosis. After admission she suffered from high fever with chills and right flank pain, and right percutaneous nephrostomy was performed. Abdominal computed tomography showed right severe hydronephrosis and right ureteral transitional cell carcinoma was highly suspected. Ureteroscopy showed right ureteral polypoid tumor and right ureteral complete obstruction. The pathological report showed endosalpingiosis. Effective renal plasma flow revealed total ERPF of total 248 mL/ min, with 245 ml/min on the left kidney and 3ml/min on the right kidney. (The renal perfusion fraction is 96% on the left kidney and 4% on the right kidney) Laparoscopic right nephroureterectomy was performed. Right ureteral retroperitoneal fibrosis and severe adhesion was met at middle third ureter and ureter was dissected till the 3cm below the ureteral polyp. We took a piece of biopsy at the cutting end and the frozen report showed ureteral endometriosis. Total operation time was 135 minutes while total blood loss was 40 ml. Recovery was uneventful and the patient was discharged under stable condition. Urinary tract endometriosis is an uncommon condition. The symptoms are nonspecific. Most Common location of ureteral endometriosis is in the lower third ureter. A upper third ureteral polypoid endometriosis causing nonfunction kidney is rare and it cause chronic pyelonephritis. Laparoscopic nephroureterectomy is a feasible method for the management of a upper third ureteral polypoid endometriosis causing nonfunction and inflammatory kidney. .In cases of ureteral endometriosis, the initial technique is determined by the location, depth of the lesion, the function of kidney and severity of infection.

PP29-48
Safety and efficacy of a superior calyceal puncture in pediatric pcnl breaches the diaphragm and is believed to have greater complications than access through other calyces. We evaluated the safety and efficacy of a superior calyceal access in pediatric patients undergoing percutaneous nephrolithotomy.

Materials and methods:
Operative and recovery data for pediatric patients (upto 16 years old) undergoing PCNL for renal calculi were prospectively entered into a database and reviewed. Patients with a superior calyx puncture were compared with those in whom the superior calyx was not punctured. Stone clearance was assessed by intraoperative fluoroscopy and postoperative X-ray in all patients and ultrasound & CT scan in selected cases.
Results: Over a two year period 26 pediatric patients (mean age 11.12 years; range 4-16 years) underwent 27 PCNLs. Stone bulk ranged from 200-1150 (mean 656.03 mm2). 9 patients had staghorn stones. Thirteen patients (14 renal units) had primary superior calyx access with thirteen of these being supracostal (above 12th rib). Four of these had staghorn calculus. All stones were fragmented using a pneumatic lithoclast. Second look PCNL was required in 3 patients. Complete clearance was achieved in all except one patient in each group with superior and non-superior calyceal puncture. One patient with supracostal puncture developed hydrothorax requiring tube drainage while one in non-superior calyx approach developed abdominal collection. Both patients recovered with no sequelae.

Conclusion:
The superior calyx puncture is safe and effective in the pediatric population. It should be used when required without fear of additional significant complications.

PP29-49
Chest complications following supracostal puncture are more common on the right side Rajeev Kumar 1 , Vaibhav Saxena 1 , Ajay Anand 1 , PN Dogra 1 , Amlesh Seth 1 , Narmada P Gupta 1 1 India Institute of Medical Sciences (India) Purpose: Supracostal access for PCNL is associated with an increased incidence of pleural complications. We evaluated the incidence of such complications, the timing of their occurrence and their relation to the site of access.

Materials and methods: From October 2007 to November
2009, data of patients undergoing PCNL through supracostal puncture (between 11th and 12th rib) was prospectively entered into a database and was reviewed for chest complications. All patients were evaluated intraoperatively by fluoroscopy followed by an X-ray chest on the evening of surgery, before discharge and whenever clinically indicated.
Results: 82 patients with an age range of 04-78 years underwent 83 supracostal PCNLs. Hydrothorax occurred in nine out of 83 (10.84%) punctures. All were in superior calyx punctures and none with supracostal isolated middle or inferior calyceal punctures. The incidence of hydrothorax in right sided punctures (18.6%: 8 out of 43) was higher than in left sided punctures (2.5%: 1 out of 40). Four patients, all with right sided punctures, had delayed hydrothorax (>48 hours) including two who developed it only after a re-look procedure through the same tract.
Conclusion: Hydrothorax following supracostal punctures occurs in about 1 out of 10 procedures. This is more common on the right side punctures. Hydrothorax may occur late after the initial surgery and, at times, may not manifest after the first surgery but appear only after a second look surgery.

Laparoscopic partial nephrectomy and ureterectomy in duplication of left kidney with obstructed upper moietya case report
Yung-Yao Lin 1 , Jong-Ming Hsu 1 1 Department of Urology, Mackay Memorial Hospital (Taiwan) Purpose: We presented a male with symptomless duplication of left kidney who accepted laparoscopic partial nephrectomy and ureterectomy.

Material and methods:
A 40-year-old male presenting with duplication of left kidney with obstructive upper moiety was referred to our department. The incidental finding of left hydronephrosis was noted at another hospital where intravenous urogram revealed space occupying lesion without contrast enhancement in the left kidney. The cystoscope showed no specific finding. A large tubular cystic lesion at upper pole of left kidney and normal excretory function of left lower kidney were showed in the abdominal CT. He denied any associated symptoms and signs such as left flank pain, or flank soreness. Furthermore, there was no recurrent UTI. Because of the poor function of the upper moiety, the heminephrectomy and ureterectomy are indicated. Laparoscopic partial nephrectomy and ureterectomy of the upper moiety were done.
Results: There was no complication noted during operation. He lost follow-up post operation.

Conclusion:
For duplication with an obstructive upper moiety, laparoscopic partial nephrectomy and ureterectomy provided minimal morbidity, minimal post-operative discomfort, better cosmetic effect and less hospital cost.

Materials and methods:
A 30-year-old man had experienced transient hemospermia for 6 months. Transrectal sonography showed a right seminal vesicle hypoechoic lesion of approximately 2.5×2.5 cm in size. IVU revealed a normal appearance of the bilateral collecting system. Vasography revealed a dilated pouch over the right seminal vesicle. MRI also indicated that the cyst originated from the right seminal vesicle. He received laparoscopic resection of the seminal vesicle cyst. The postoperative course was smooth. The pathological report concluded a seminal vesicle cyst without malignancy. The subsequent semen analysis was normal and the hemospermia had subsided after a 4-month follow-up.

Results:
Cysts of seminal vesicles may be either congenital or acquired and are thought to be due to obstruction of the ejaculatory duct. Many studies have shown an association between seminal vesicle cysts and other abnormalities, including renal agenesis, infertility, hemospermia, genitourinary infection, and adult polycystic kidney disease. No treatment of a seminal vesicle cyst is needed if the cyst is asymptomatic. Symptoms include bladder irritation, perineal or suprapubic pain, hematospermia, postcoital discomfort, infertility, epididymitis, and prostatitis. Several surgical approaches have been reported, namely, open transvesical, transperineal, retroperitoneal, posterior transcococcygeal, and laparoscopic approaches. Results: All procedures were successful. The mean operation time of extraperitoneal CUTE was 328 minutes. The time to oral intake was 2.6 days and to ambulation was 4.6 days. The mean parenteral narcotic requirement was 43.6 mg (range 12 to 88.6 mg) of morphine. No patient had recurrent TCC at a mean follow-up of 27.8 months.

Conclusions: Extraperitoneal CUTE via a lower midline incision in a completely supine position is feasible and safe.
This technique has the benefit of easy supine positioning, eliminates the need for inter-procedural repositioning, avoids bowel interference of the visual field, and reduces the risk of possible mechanical bowel injury of a retroperitoneal approach. This approach is a rational option when CUTE is considered.

Purpose:
The retrocaval ureter is a rare congenital anomaly due to the persistence of the subcardinal vein on the right side. Traditionally, open reteroureterostomy was the surgical treatment for the retrocaval ureter. The laparoscopic pyeloplasty is becoming the golden standard for surgical correction of ureteropelvic junction obstruction. The laparoscopic dismembered pyeloplasty for retrocaval ureter is more challenging technically. We present a female case of retrocaval ureter treated with laparoscopic dismembered pyeloplasty in E-Da Hospital.
Case report: This 26-year-old female patient without medical history had mild right flank pain sometimes. Retrocaval ureter was diagnosed by intravenous pyelography and computed tomography urography. Surgical intervention was suggested. Under general anesthesia, the patient was placed in the 45-degree left lateral decubitus position with separation of bilateral legs. Ureteroscopy was done first and then a 10 Fr. ureteral access sheath was advanced upwardly. Transperitoneal approach was used by a standard four-port technique. The interaortocaval region of the right ureter was identified. Insert the 4 Fr ureteral catheter through the ureteral access to help identification of the ureteral lumen and its axis. Dissection was done alone the ureter and inferior vena cava. The renal pelvis and the ureteropelvic junction were dismembered and mobilized anteriorly to the inferior vena cava. A hydrophilic guidewire was inserted through the ureter sheath. Ureteroureterostomy was performed with 3-0 vicryl by laparoscopic interrupt suture in tension-free fashion. A 6Fr×26 cm JJ stent was insert via the ureteral access sheath alone the guidewire. The operation was completed laparoscopically without open conversion. The operating time was 240 minutes. The blood loss was minimal and there was no blood transfusion. She took regular diet on postoperative day 2 and discharged on postoperative day 4. No intraoperative complications occurred. The JJ stent was removed 6 weeks postoperatively. Intravenous pyelography shows patent of right ureter when 4 months after operation and there is no more right flank pain clinically.

Laparoscopic partial nephrectomy for renal mass: experience in Mackay Memorial Hospital
Chih-Chiao Lee 1 , Wun-Rong Lin 1 , Wen-Chou Lin 1 , Huang-Kuang Chang 1 1 Department of Urology, Mackay Memorial Hospital (Taiwan) Purpose: Laparoscopic partial nephrectomy(LPN) is increasingly a definitive therapeutic option in patients with a select small renal mass. We report our initial experience in LPN by evaluating retrospectively collected data on tumor characteristics, perioperative outcomes, postoperative outcomes and renal function outcomes.

Material and method:
From 1996 to 2010, there were 5 patients under LPN with retroperitoneal approach by one surgeon in our institution. Baseline demographics, intraoperative parameters and postoperative parameters were reviewed retrospectively. Renal function was evaluated by baseline creatinine level and its variation after operation accompanied with glomerular filtration rate (GFR) according to the MDRD equation.
Results: In our study, mean patient age was 59.6 years old, and mean tumor size was 4.26 cm. The clinical stage in all cases were T1a or T1b. All tumors were in exophytic peripheral location except one was in central hilum of kidney. All of our cases underwent Retroperitoneal approaches in LPN. Two patients with tumor size of 6cm in diameter received renal artery clamping with ischemia time of 45 mins and 70 mins. Collecting system was involved in these two cases resolved by renorrhaphy. There were no urine leakage after operation. Two cases had conversion to open partial nephrectomy due to renal artery injury during remove of Hemo-o-lock and difficult to control renal pedicle. In our patients under LPN successfully, there were no postoperative complication including hemorrhage or urine leakage. Mean operative time in successful LPN A321 was 222 minutes. Mean blood loss was 187.5cc. Of all renal masses, five were pathologically confirmed renal cell carcinoma without any positive surgical margins. There were also no significant change in renal function after LPN in our cases. At a median follow-up of 11.25 months, there was no tumor recurrence in these patients under LPN.
Conclusion: LPN is a challenging urologic operation with potentially major complications. However it can be performed in selected patients by experienced laparoscopic surgeons. The retroperitoneal approach to LPN can be performed in a safe and timely manner with good perioperative, postoperative and renal function outcomes.

Laparoscopic excision of ectopic ureter with vesicoureteral reflux and recurrent urinary tract infection
Yung-Tai Chen 1 , Jun-Kai Wang 1 , Jih-Sheng Chen 1 , Shin-Hong Chen 1 1 Department of Urology, Taiwan Adventist Hospital (Taiwan) Purpose: We reported on a case of right atrophic kidney with duplication of ureter(including one ectopic ureter). The ectopic ureter combined with vesicoureter reflux. The orifce was detected at proximal urethra. Recurrent urinary infection attacked three times within one year. We performed laparoscopic excision and reported our experience.

Materials and methods:
A 37-year-old female had frequent urinary tract infection for several years. She suffered from 3 times of recurrent urinary tract infection in the year of 2009. Urine culture revealed Proteus mirabilis infection. Intravenous urography showed bilateral ureter duplication including one ectopic right ureter. Right atrophic kidney was also disclosed. Voiding cystourography showed ureterovesical reflux of the ectopic ureter. Urethrocystoscopy unveiled the orifice located at proximal urethra. We arranged laparoscopic excision of the ectopic ureter. A camera port was created subumblically, two working ports were indwelled at bilateral lower abdomen.
A ureteroscope was inserted into the ectopic ureter during operation to assist identification of ureter. The illumination of ureteroscope helped greatly to discover the ureter. The peritoneum was incised to expose the ureter. The ureter was dissected from kidney down toward bladder and excised. A rubber drain was indwelled.

Results:
The postoperative course was smooth. The patient started oral intake two days postoperatively. She regained ambulation on the same day. She was discharged without fever, abdominal wound pain. She went back to work soon after discharge.
Conclusion: Laparoscopic ureter excision was safe and feasible. The postoperative recovery is good.

PP29-57
Adrenal leiomyoma -a case report and review of literature

Materials and methods:
A 62 year old female complaining a poor controlled blood pressure for a long time and vague abdominal pain for several months. Abdominal computed tomography showed one 1×1 centimeter bulging mass arising from lateral limb of left adrenal gland. Laboratory data showed elevated serum aldosterone level.

Results:
The patient underwent laparoscopic left adrenalectomy without complications. Total operation time was 90 minutes while 30 ml blood loss was found during the operation. Pathology examination revealed left adrenal leiomyoma.

Conclusion:
Adrenal leiomyoma is a rare benign tumor arising from adrenal gland and less than 100 cases ever reported in world literature. Laparoscopic management of adrenal leiomyoma is an effective method to treat such a rare tumor.

PP29-58
Thulium laser laparoscopic partial nephrectomy for the management of benign renal tumor Yu-Wei Lai 1,2 , Yi-Chun Chiu 1,2 , Andy C. Huang 1,2 , Thomas Y. Hsueh 1,2 , Allen W. Chiu 1,2 , Shiou-Sheng Chen 1,2 , Shing-Hwa Lu 1,2 1 Divisions of Urology, Department of Surgery, Taipei City Hospital (Taiwan) 2 Department of Urology, National Yang-Ming University, School of Medicine (Taiwan) Introduction: Laparoscopic partial nephrectomy is a technically challenging procedure. The most challenging part for laparoscopic partial nephrectomy is the meticulous intracorporeal suturing in a limited time period. Thulium laser has been reported to treat enlarged prostate with comparable results to conventional transurethral resection of prostate. It has been reported the application of thulium laser in laparoscopic partial nephrectomy for the management of renal tumor. Herein we reported our preliminary experience in thulium laser partial nephrectomy for the management of benign renal tumor and review the world literature.

Case report:
We reported the 39 year-old female presented with a left renal mass found incidentally. Abdominal computed tomography showed one centrally located left renal mass measuring 2.2×2.4×2.5cm with contrast enhancement and central necrosis. Laparoscopic partial nephrectomy with thurlium laser was done using five-trocar method. Total operation 155 minutes, warm ischemic time 9 minutes and total blood loss was 50 ml. Pathological examination showed angiomyolipoma. Convalescence was uneventful and the patient was discharged under stable condition.

PP29-59
Hand assisted laparoscopic bilateral polycystic kidney nephrectomy-a case report and literature review Chao-Chun Shiau 1 , Chien-Jung Huang 1 , Yu-Wei Lai 1 , Thomas Y Hsueh 1 , Shiou-Sheng Chen 1 , Lee-Jin Hsiao 1 , Sun-Yran Chang 1 , Allen W. Chiu 1 1 Taipei City Hospital Renai Branch (Taiwan) We reported a case of 68 years old male who have bilateral polycystic kidney disease for more than a decade. Because of the deterioration of abdominal fullness and distension, we perform the hand assisted laparoscopic bilateral radical nephrectomy for this patient. Abdominal computer tomorgraphy shows bilateral polycystic kidney. We performed hand assisted bilateral laparoscopic radical nephrectomy on 2008/07/23. We made a surpaumbilical 7 cm incision at midline for GelPort ® , two 10mm trocars for the Endoscopic Gastrointestinal anastomosis (EndoGIA) stapling device and laparoscoic lens entry port, and two 5mm trocars for the laparoscopic grasper and suction/lavage unit. The surgical table was rotated for better visualization of the bilateral kidney. Abdominal viscera were carefully identified under hand palpation though GelPort ® t and retroperitonium access was established under laparoscopic coagulator grasper and hook. After dissecting the surround structure of kidney, EndoGIA staple was applied for renal vessel and ureter. Then kidney was removed through midline incision of GelPort ® . Extreme caution and gentle maneuver were taken to minimized cyst rupture during the dissection. The same procedure was performed for dissection of contralateral kidney. Jackson-Pratt drainage tubes were inserted, and wounds were clearly close layer by layer in aseptic process. The whole surgery took 5 hours and 15 minutes, and the blood loss was about 1200ml. Two polycystic kidneys and ureters were successfully dissected and removed. The weights of the left and right kidney were 980gm and 770gm, respectively. The whole surgical procedure was smooth and no intraoperative or postoperative complications were noted. Hand assisted bilateral laparoscopic radical nephrectomy is a feasible method for reducing the surgical morbidity compared with traditional open bilateral nephrectomy for bilateral polycystic kidney.

Results:
The first case is a 20-year-old female patient. She took recreational ketamine intermittently for about 2 year. She suffered from LUTS and asked for help. Renal echo showed left hydronephrosis but bladder wall no thickening. CT scan showed left hydronephrosis and ureteral wall thickening. Later she stopped use ketamine and hydronephrosis resolution. The second case is a 24-year-old female patient. She took recreational ketamine for about 3 years. Renal echo and CT scan showed bladder wall thickening and bilateral hydronephrosis. Uretral wall was mild thickening. VCUG showed no reflux. The third case is a 26-year-old male patient. He took ketamine for 4 years. Renal echo and CT scan showed left hydroneprosis and bladder wall thickening. Uretral wall was also thickening. Renal echo and CT scan will be presented. The degree of bladder and uretral wall thickening will be showed.

Conclusion:
Long-term ketamine abuse tends to impair bladder function. More cases shows upper urinary tract impairment about ketamine abusers. Hydronephrosis but no UV reflux was identified at our 3 patients. Ureteral wall thickening was showed by CT scan. Uretritis may be the cause of hydronephrosis.

Education and Research (India)
Purpose: Perineal urethrostomy is used to circumvent difficult long segment anterior urethral strictures, especially in high risk patients. Management of Stenosis of perineal urethrostomy is a daunting task with limited options. Use of buccal mucosa in revision of obliterated perineal urethrostomy has rarely been reported. We present our experience of use of Buccal Mucosa for this purpose in two patients.

Materials and methods:
Both patients were elderly males in seventies; one had multiple failed repairs for pan-anterior urethral stricture disease and the other had pelvic fracture urethral distraction defect along with multiple anterior urethral strictures. In view of age, co-morbidities and need for complex/staged anterior urethral repair; both underwent perineal urethrostomy elsewhere. Both the cases developed stomal stenosis refractory to dilatations and were on suprapubic tube. We salvaged perineal urethrostomy using U shaped perineal skin flap augmented on dorsal aspect by Buccal Mucosa. There was no donor site morbidity.

Results:
The repair was successful in both cases and patients were free of suprapubic tubes in 4 weeks time. Patients were kept on close follow up with supervised self caliberation for 3 months. At 18-24 months follow-up, both are voiding well.

Conclusion:
Buccal mucosa is a useful graft for epithelial coverage to salvage failed perineal urethrostomy and carries minimal donor and recipient site complications.

PP29-62
A rare complication of transrectal ultrasound guided prostate biopsy -rectourethral fistula ATL Ng 1 , KKF Fu1, SCH Yee 1 , SWH Chan 1 1 Urology Division, Department of Surgery, Queen Elizabeth Hospital (Hong Kong) Introduction: Transrectal ultrasound guided prostate biopsy (TRUS Bx) is the standard procedure for investigation of raised prostate specific antigen (PSA) levels or abnormal digital rectal examination (DRE) findings. It is considered a safe and effective diagnostic tool. However, TRUS Bx is not completely free from serious complications. We report a case of rectourethral fistula (RUF) post TRUS Bx, presenting with sepsis.
Case report: A 84 gentleman with good past health presented with incidental finding of raised PSA level of 35 ug/L. DRE showed an enlarged, hard and fixed right lobe of prostate, with obliteration of median groove. TRUS Bx was arranged. Three days of oral ciprofloxacin 500mg bd as antibiotics prophylaxis and fleet enema were given before the procedure. Sextant TRUS Bx was performed by radiologist. The prostate gland was markedly enlarged, > 200ml in volume; with irregular outline and distorted internal anatomy. Pathology came back to be adenocarcinoma of prostate, GS 4 +4 over all six cores. Bone scan showed bone metastasis over sacro-coccygeal and bilateral acetabular regions. He was readmitted for post-TRUS Bx fever 2 days afterwards, which did not subside with intravenous antibiotics: Sulperazone (Cefoperazone/ sulbactam) and metronidazole. Urine culture yielded insignificant count, whereas blood C/St grew Bacteroides species. White cell count was persistently elevated at 24.5 ×10^9/L. He developed abdominal distension and DRE showed irregular mucosa over anterior rectal wall CT abdomen & pelvis with contrast showed prostate abscess, rectal perforation with intestinal obstruction, and enlarged prostate with lost of fat plane with seminal vesicles. Defunctioning transverse colostomy was performed due to overt sepsis and an attempt to allow the fistula to heal. Reassessment CT scan 2 months later showed no residual prostate abscess. Loopogram via rectum and transverse colostomy showed no leakage of contrast into urinary system. Closure of colostomy is pending. Concerning the treatment of CA prostate, he opted for hormonal treatment with LHRH agonist. The latest PSA is <0.1 ug/L.

Discussion:
The most common cause of RUF in modern series is post-radical prostatectomy. Other causes include cryotherapy, pelvic radiotherapy and anorectal surgery. It is rare for rectourethral fistula to occur post TRUS prostate biopsy. Patients with RUF present with urine per rectum, pneumaturia, recurrent urinary tract infections or fecularia, or rarely, as in our case -overt sepsis. There are two approaches in the management of RUF: conservative Vs surgical. Conservative management includes faecal diversion with colostomy and either suprapubic cystostomy or indwelling urethral catheter. The rationale behind conservative management is to allow symptomatic control and attempts to allow spontaneous healing of the fistula. However, conservative management is unpredictable and the time to allow healing is unknown. In our case, the RUF healed with a period of defunctioning colostomy.

Conclusion:
We have described a case of rectourethral fistula after TRUS Bx, which resolved with defunctioning colostomy and antibiotics. To our knowledge, this is the first reported case of post TRUS Bx rectourethral fistula.

PP29-63
Transarterial embolization for various kinds of renal bleeding: three case reports Materials and methods: A 54-year-old man suffered from sudden onset of severe right flank pain and shock, and was sent to ER. CT scan showed a giant right renal angiomyolipoma, 17cm in size, with large hematoma in it. Small size of right renal parenchyma and another two large left renal angiomyolipomas were also noted. His hemoglobin was only 7.4mg/dl. A 56-year-old man had persistent gross hematuria for more than three months. Ureteroscopy showed bleeding from right kidney. CT and MRI studies revealed severe hydronephrosis and non-functioning right kidney, without tumor in it. PCN was performed on the patient and gross hematuria had no response to medical treatment. A 71-yearold man was a case of prostate cancer with right UVJ obstruction. Right PCN was done. Unfortunately, right flank pain and drop of hemoglobin to 7.8mg/dl were noted after PCN. CT study showed massive retroperitoneal hematoma.

Results:
Transarterial renal artery embolizations with metallic coils were done smoothly for the first two patients. For the last patient, selective embolization of the bleeding right middle renal artery with microcoils was done smoothly. The bleeding conditions were stopped successfully and immediately. All of the patients recovered uneventfully without complication and no recurrent bleeding during 2 year follow-up. Purpose: We report two cases of multiple torso injuries after traffic accident. Both cases were found to be victims of intraperitoneal bladder rupture by cystoscopy finally. We try to review literatures, so as to avoid misdiagnosis of traumatic intraperitoneal bladder rupture after completion of image studies.

Case reports:
The first case is a 50 years-old man, he sustained multiply injuries of brain contusion with skull bone depressive fracture, deep laceration of forehead, chest contusion with right 2nd to 8th ribs facture and pneumothorax. His urine routine revealed 100-200 red blood cells every high power field. CT scan of abdomen showed intraperitoneal fluid surrounding the liver. He underwent cystofibroscopy due to progressive gross hematuria immediately after operation for skull laceration, which disclosed a 7-8 cm laceration located at dome of urinary bladder. Repair of urinary bladder was done and he was well eventually. The second case is a 29 years-old man, he suffered from multiply injuries of left renal hematoma, blunt abdominal injury with mild liver laceration with internal bleeding and multi-sites of limbs fractures. During hospital course, oligouria, acute renal insufficiency and suspected urine ascites led to performance of cystofibroscopy for bilateral retrograde pyelography. Thereafter, a 3-4 cm laceration located at dome of urinary bladder was noted. He received repair of urinary bladder and mad a quick recovery ultimately.

Discussions:
Missed or delayed diagnosis of urinary bladder rupture could be a catastrophe. As routine use of conventional CT scan of abdomen on unstable hemodynamic patients is popular at emergent institutes. When surgeons encounter traumatic patients with blunt abdominal trauma or associated with pelvis fracture, sentinel clots sign and intraperitoneal free fluid should arouse surgeon s high suspicion of urinary bladder rupture. A concomitant or subsequent well-planned CT cystography will make diagnosis of urinary bladder rupture easier. Surely, conventional retrograde cystography is still a gold standard for patients with highly suspicious urinary bladder rupture in any time. However, as an urologist, cystofibroscopy is an ultimate and final protection to escape from missed or delayed diagnosis of urinary bladder rupture when patients are in operation room.

Conclusion:
Missed or delayed disclosure of urinary bladder rupture can been prevent by precise interpretation of conventional CT scan, planned CT cystography or undergoing retrograde cystography.

PP29-65
Fish bone induced colovesical fistula on a patient with strokea rare case report and literature review Colovesical fistula is the most common form. The primary mechanism is rupture of a diverticulum or a peridiverticular abscess into the bladder. Some studies report a risk of 2% to 4% in patients with diverticulitis to develop enterovesical fistula. Our stroke patient was induced by a foreign body, and this is a rare etiology. No IPSS, and one AUASI were found in NEJM .

Conclusion: American Urological Association symptom index is not identical to International Prostate Symptom
Score. The urologists and the editorial boards of medical journals are encouraged to be aware of the differences.

Ming University (Taiwan)
Renal angiomyoadenomatous tumor (RAT) is a very rare neoplasm of the kidney. It is microscopically characterized by leiomyomatous stroma often forming abortive vascular structures surrounding and encasing a distinctive epithelial component. So far only five cases of RAT were reported in the literature. Herein we presented a 79-year-old Taiwanese male with RAT. He received annual examinations and abdominal CT showed a 2.3 cm renal tumor at interpolar region of right kidney. Neoplasm such as renal cell carcinoma is first considered. He denied hematuria, flank pain or palpable mass during the whole clinical course. Further examinations including whole body bone scan and chest radiograph disclosed no evidence of metastasis. Effective renal plasma flow showed right kidney was 148.0 ml/min and left kidney was 241.3 ml/min. Then, he received right laparoscopic partial nephrectomy smoothly. The post-operative course was uneventful. Pathology revealed RAT. RAT was first described by Michael et al. in 2000. It was benign in behavior and no disease related mortality has been reported in the literature. Macroscopically the tumor was characterized with a sharply circumscribed tumor with microcystic or macrocystic changes. Microscopically, the stroma was composed of leiomyomatous vascular structures surrounding and encasing the epithelial component, which contained adenomatous structures composed of cells with small deeply basophilic nuclei alienated along the basal membrane.

Azmi Omar (India)
Despite the inaccessibility of the bladder particularly in male, many cases of self introduction of different items of foreign bodies into the bladder have been reported. Most were associated with mental illness, senility, psychiatric abnormalities or for sexual purposes as the underlying cause. We report a case of a candle inserted into the urinary bladder by a 21 years old adult male, who presented with suprapubic pain, recurrent haematuria and dysuria for more than 18 month. The radiolucency of the foreign body added difficulty in the diagnosis. He received multiple courses of antibiotic for chronic cystitis, including anti Tuberculosis for three months with no improvement. The FB was finally diagnosed by CT scan and MRI and was found to be a candle which was extracted cystoscopically. FB should be suspected in chronic cystitis which is not responding to medical treatment.

Materials and methods:
A retrospective review of the operating theater database yielded the details of patients who underwent operative repair of bladder injuries. Patients who sustained bladder injuries due to non-surgical reasons (such as traumatic bladder injuries due to pelvic fractures, blunt trauma or penetrating injuries to the pelvis) were excluded.
Results: There were twelve cases of iatrogenic bladder injury treated during that time period. A total of eight injuries occurred during gynaecological surgery. Five injuries occurred during lower segment caesarean section (LSCS), two injuries during total abdominal hysterectomy and bilateral salpingo-oopherectomy (TAHBSO) and a single injury during Burch colposuspension. Of the four remaining non-gynaecological related injuries, two iatrogenic injuries occurred during hernioplasty, one during exploration of an enterocutaneous fistula and the other was during laparoscopic appendicectomy. Ten patients were successfully treated with no complications and have remained well. One patient died due to unrelated causes. Another one, with a posterior wall intraperitoneal injury during LSCS, needed to be on catheter for three months due to persistent bladder leak. Her urine culture showed Escherichia coli infection which was sensitive to cefuroxime. She was put on prolonged antibiotics. A repeat cystogram and urine culture at three months showed that the bladder had healed completely without any contrast extravasation and there was no more urinary infection. The catheter was removed and she has remained well at six months of follow up Conclusion: Iatrogenic bladder injury should be anticipated in patients undergoing caesarean section who have multiple previous caesarean sections previously. Iatrogenic A329 injuries should be identified intra-operatively to enable early repair and the best outcome. Continuous repair with absorbable sutures together with perivesical drainage and bladder catheterization produces good outcome. Ascending cystography using a minimum of three hundred millilitres of contrast with two views and a post emptying film is the best modality for the diagnosis of iatrogenic bladder injury and also for the assessment of the integrity of repair.

PP29-71
Ratios of fre to total prostate -specific antigen and total prostate specific antigen to protein concentrations in saliva and serum of healthy men Purpose: We evaluated the ratio of tree to total prostatespecific antigen (PSA) and PSA to protein concentrations in saliva and serum of healthily men.

Materials and methods:
Consecrations of protein, free PSA, and total PSA in serum and saliva measured in 30 healthy men aged 42 to 73 years, and their ratios were compared between the two fluids.

Results:
There was a significant direct correlation between serum free-total PSA ratios of serum and saliva (P = 0.04) and between total PSA protein ratios of serum and saliva (P = 0.02). Also, there were significant correlations between total and free PSA levels in saliva (P = 0.05) and between those in serum (P < 0.001). Significant inverse and direct correlations were detected between the body mass index and serum values of total PSA -protein (P = 0.04) and free total PSA (P = 0.01), respectively.

Conclusion:
We can use saliva sample instead of serum sample for estimation of free total PSA and total PSAprotein levels in men without prostate diseases. There is, however, a pressing need for much additional research in this area before the true clinical value of saliva as a diagnostic fluid can be determined.

PP29-72
A randomised cross-over study of silver-coated siliconecoated Foley's catheter and 100%silicone Foley's catheter in patients requiring long term indwelling catheters.

Materials and methods:
Patients who met the inclusion and exclusion criteria were randomized into the ASC and SSC groups. There was a mandatory cross-over to the other group after the 3rd month. However patients who experienced adverse events or unhappy with existing catheter but still keen to continue with the study were allowed to cross-over earlier. Urine chemistry, urine full examination and microscopic elements (UFEME), urine culture and sensitivity will be taken at week 0, 1, 2 and 4. Any adverse events, CAUTI and patient satisfaction scores were recorded at each visit. A 24-hour urine chemistry was taken before the 3rd catheter change.
Results: 12 patients, mean age of 68.4 years old were recruited and follow-up for a mean of 2.25 months. CAUTI rates and catheter blockage rates were significantly higher in the SSC group. Patient satisfaction scores were significantly lower in the SSC group. There was no difference in the time for colonization of catheters and bacteruria rates between the two groups. SSC seems to resist colonization by E coli but increases the risk of S aureus colonization. The study was terminated prematurely due to increased adverse events reported in the SSC group.

Conclusion:
The Hydrogel silver-coated silicone catheter (SSC) was not superior to all-silicone catheter (ASC). In fact Hydrogel silver-coated silicone catheter( SSC) might be associated to increased CAUTI and complication rates.

PP29-73
The role of MRI in the evaluation of scrotal swellings PM Deka, SW Hasan, TP Rajeev, SJ Baruah (India) Purpose: Scrotal pathology is very common in clinical practice. Ultrasonography is usually the initial imaging modality for evaluation of pathologic conditions of the scrotum. However, magnetic resonance imaging has shown high sensitivity and specificity. MRI demonstrates exquisite anatomical detail of the entire scrotum and inguinal region, adding a new dimension to the assessment of scrotal disease.: Aim of this study is to evaluate the role of MRI in various scrotal pathologies and to compare it with ultrasonography.

Materials and methods:
The duration of the study was 1 yr (From Sep/08 to Aug/09). 21 patients with scrotal pathology were included in the study.The age range was 20-67 yrs with a mean of 36 yrs. All patients were evaluated by a detailed history, physical examination and various laboratory studies including tumor markers if indicated. Patients were subjected to USG (Siemens Accuson Antares/ 7MHz) and MRI of the scrotum (Siemens Magnetom Advanto/1.5T). A final diagnosis was made depending on clinical features, imaging studies, FNAC and histopathology. Patients in whom surgical intervention was necessary; intraoperative findings and histopathology were considered in the final diagnosis. Previously treated patients and having any contraindication for the imaging studies were excluded from the study.
Results: Out of 21 cases 10 patients had epididymoorchitis, 5 had epididymal cyst, 2 had testicular tumor and 4 had tubercular epididymo-orchitis. USG correctly diagnoses all cases of epididymal cysts and testicular tumors. Of the 4 cases with tubercular epididymo-orchitis USG was correct in predicting the diagnosis in 2 cases while 9 of 10 cases with epididymo-orchitis were correctly diagnosed with USG. MRI could correctly diagnose all 4 cases of tubercular epididymis and both cases of testicular tumor.

Conclusion:
Preliminary analysis of the data shows that MRI is an excellent modality of imaging for scrotal pathology with a very high sensitivity and specificity. In the present study MRI was able to differentiate correctly between inflammatory and neoplastic conditions. Among the inflammatory conditions it was able to correctly differentiate granulomatous from non-granulomatous pathology.

PP29-74
The relationship between androgen receptor gene CAG repeats length and long term outcome of intramuscular testosterone undecanoate therapy in 183 Thai late onset hypogonadal men Sompol Permpongkosol 1 , Nakorn Tantirangsee

Results:
The repeat length CAG was between 14-31.
The most CAG length was median (20-23) with low testosterone. Men with longer CAG receptor had higher levels of total T and AMS score. There was no association between repeat length and any of the anthropometric measure. Testosterone therapy was associated with a significant decline of waist circumference (p=0.050) and of percentage body fat (p < 0.001), but no change of BMI. Objective: To evaluate the safety of living related donors after transplantation and study the long-term psychosocial outcomes in those donating a kidney by using Thirty sixitem questionnaires (SF-36) health-relative quality of life.
Material and method: Two hundred and forty cases of living related donor kidney transplantation from January 1997 to December 2006 were analyzed retrospectively. There were 72 male and 136 female aged from 19.5 to 68.9 years old, with a mean of 37.6±10.46 years old. The indexes were compared including serum creatinine (SCr), before and after donation. Surgical complications were followed-up. SF-36 questionnaires health-relative quality of life was posted to all patients and the response rate was 186 (77.5%).

Result:
The Intra operative complication rate was 1.08% (2 cases); a left upper ureter injured and accidental tear adrenal gland, respectively. No postoperative complication was reported. The mean follow up was 3.1±2.5 years (2 months -11 years). Donors' serum creatinine was (0.94±0.1) mg/ dL before donation, (1.09 +/-0.28) mg/dL at 2 years after donation ( p< 0.01). There was no significant difference in clinical between any 2 time points since the value was in normal range. The average donor quality of life after donation, as measured by the SF-36, was better than that of the general US population. However, when compare among the donors of many country, most of our score was not highest, except the Bodily pain score. Although 94.9% of the donors would make the same choice again, 5.14% were dissatisfied and regretted their decision to donate a kidney.

Conclusion:
Most living donors enjoyed not only the safety of living after transplantation but also the long-term excellent quality of life including psychological and social effects.

PP29-76
An improvement of both voiding and sexual dysfunction in 313 Thai men with lower urinary tract symptoms after an uroselective 1-blocker treatment Objective: To study the relationship between erectile dysfunction (ED) and lower urinary tract symptoms (LUTS) and analyze the effect of an uroselective 1-blocker, on sexual function of Thai patients with benign prostate hypertrophy (BPH).

Patients and methods:
Of the 488 Thai men with LUTS and treated with alfluzosin monotherapy at a men s health clinic, 313 men (64%) with LUTS completed 8 months of the treatment and all of the questionnaires; (1) the International Prostate Symptom Score (IPSS) which rates LUTS severity, and (2) International Index of Erectile Function (IIEF)-5 questionnaires, which evaluates the grading of ED symptoms. The relationship between IPSS score, IIEF-5 and selected clinical characteristics was analyzed using multiple regression analysis. For the comparisons at baseline and changes from baseline in the overall population, a chisquared or Fisher s exact test was used for qualitative variables and a t-test for quantitative variables, with p < 0.05 taken to indicate statistical significance.
Conclusion: Treatment with alfuzosin 10 mg OD is safe, and in this pilot study was the most effective therapy to enhance both voiding and sexual function in Thai men with LUTS and sexual dysfunction.

Materials and methods:
From September 2008 to February 2010, 22 patients underwent single port transumbilical laparoscopic surgery: nephrectomy for a nonfunctioning kidney (9 cases), cyst decortications for symptomatic renal cyst (10 cases), redo-dismembered pyeloplasty with previously failed laparoscopic surgical repair (1 case), ureterolithotomy (1 case) and ureteral reimplantation (1 case), respectively. Patients underwent surgery through a single 2-3 cm infraumbilical incision with the single port. All pathological reports of LESS nephrectomy and cyst decortications confirmed with chronic pyelonephritis and simple cysts, respectively. Histology of xanthogranulomotus pyelonephritis showed two cases of the nephrectomy procedure.

A333
Results: LESS was a possible and safe approach in 81.8 % of patients. All LESS cyst decortications, ureterolithotomy, ureteral reimplantation and redo-pyeloplasty were completed without major complications or conversion to open surgery. Less intracorporeal suturing was successful in ureteral reimplantation. However, there was 1 case of each LESS cyst decortication and pyeloplasty requiring an additional 3-mm port for suturing due to bleeding and an instrument error, respectively. For LESS nephrectomy, two with higher waist circumference were converted to standard laparoscopic nephrectomy due to failure to progress. One post operative complication of incisional hernia occurred in a patient with chronic bronchitis and asthma.
Conclusions: LESS for the management of benign kidney diseases is an effective and safe treatment option with selected patients.

PP29-78
Unusual obstructive uropathy in a male patient with Down Syndrome and hematuria We report on a fifty-two-year-old Down Syndrome man with hematuria. He was thought as urinary bladder tumor with hematuria and transferred to our hospital. The physical examination showed balanoposthitis with phimosis. The intravenous pyelography revealed right obstructive uropathy and a filling defect over right bladder wall. (fig.1.) The cystoscopy demonstrated thickening bladder wall( fig.2.) and biopsy proved inflammation reaction. After dorsal slit and Foley-catheter-indwelling, the patient got recovery from renal function impairment. This case remind ourselves of a phimosis in Down Sydrome male may develop obstructive uropathy.

PP29-79
Treatment seeking behaviour in Asian patients with probable overactive bladder B Yang 1 , YC Chuang 2 , B Lojanapiwat 3 , CA Mochtar 4 , P Ng 5 1 Senior Regional Medical Director (Singapore) Purpose: Overactive bladder (OAB) is characterised by various symptoms including urgency, with or without urinary incontinence, frequency and nocturia. Individuals with OAB form a diverse population with respect to the specific symptoms experienced and their severity. The current survey evaluated consultation and treatment seeking behavior in the public and private clinic settings amongst Asian patients with probable OAB.

Materials and methods:
Patients aged ≥35 years seeking a consultation at 30 public and private clinics involving four specialties (GPs, internists, obstetrics/gynaecology and urologists) based in Malaysia, Indonesia, Thailand and Taiwan were recruited between November 2008 and December 2009. Patients were randomly selected to complete a 4-page structured questionnaire which incorporated elements of the OAB-V8 and the International Prostate Symptom Score (IPSS). Based on their response to the OAB-V8 questionnaire, patients were classified as having either probable OAB or no OAB. Patients with a total score of ≥8 were considered to have probable OAB. Results: A total of 1800 subjects completed the survey; subjects were primarily Chinese (40.8%), Indonesian (24.4%) and Thai (22.9%). 554 (30.8%) were classified as having probable OAB. Of those patients with probable OAB, 62.3% were male, 37.7% were female, and 48.2% were aged >60 years. In patients with probable OAB, 41.9% indicated that they were seeking treatment for a bladder, prostate or urinary problem, while 42.2% were seeking treatment for other problems, and 23.5% presented for a routine examination (there may have been more than 1 reason for the current consultation). More than 60% of patients with probable OAB have discussed their urinary problems with their physician within the last 6 months. However, these patients were more likely to discuss their urinary problems with a urologist (87.3%); similar proportions of patients with probable OAB discussed their bladder, prostate or urinary problem with an obstetrician/ gynaecologist (40.0%), internist (40.5%) or GP (39.6%). Interestingly, a higher proportion of female versus male patients with probable OAB did not think they had any bladder/urinary problems (Table 1: 68.5 vs. 54.7%), while male patients with probable OAB were more likely to consider that OAB is a normal part of ageing ( Table  1:15.1%vs.10.5%) and think that it is fine as long as they can'still cope'with it. In patients subsequently diagnosed with OAB, tolterodine (15.7%), and, in males, tamsulosin (12.9%) were most commonly prescribed. No medication was prescribed in 26.5% of patients with OAB. Conclusion: A notable proportion of patients with probable overactive bladder were not currently seeking treatment for urinary problems, and female patients with probable overactive bladder were more likely to think that they had no urinary/bladder problems. Patients who sought treatment for urinary, bladder or prostate problems primarily consulted a urologist, and these patients were more likely to request treatment for their overactive bladder.

Purpose:
We compared the re-stricture rate between internal urethrotomy with laser and cold knife in patients who had complication of urethral stricture after urethral trauma.

Materials and methods:
Between January 2000 and December 2008, 22 patients who had urethral disruption due to trauma and complicated with urethral stricture later were enrolled into this study. Ten patients had been involved in motor vehicle accident; 8 patients were victims of crushing injury; 3 and 1 patients sustained blunt and penetrating pelvic injury, respectively. Seven patients had partial disruption of urethra, and 15 patients had complete avulsion of urethra. Eight patients had treated with realignment of urethra within two weeks either with open repair or cystoscopic interlocking realignment, the other of 14 patients had been delay treated with urethral realignment more than two weeks after the accident happened. The average duration of stricture occurred after realignment was 77.1 days. After the urethral realignment six patients underwent internal urethrotomy with Nd:YAG laser for urethral stricture and 16 patients were with cold knife. The mean re-stricture duration was 58.5 days.
Results: Among patients who received internal urethrotomy with Nd:YAG laser, 3 (50%) patients had re-stricture. Among patients underwent internal urethrotomy with cold knife, 14 (87.5%) had re-stricture of urethra. The p-value was 0.08 and the odds ratio of cold knife to laser was 7.

Conclusion:
Although there was no statistic significance between internal urethrotomy with laser and cold knife for post-traumatic urethra stricture, there was still trend that laser would result in less urethra re-stricture due to less of secondary trauma and bleeding. From this study, the restricture rate of patient treated with Nd:YAG laser was lower than the patient treated with cold knife.
complex plays a major role in mammals. Previous reports have suggested that the bladder epithelial barrier may be compromised in interstitial cystitis (IC). We study the changes of tight junction proteins (occludin and ZO-1) in patients with IC.

Materials and methods:
Bladder biopsies from 26 patients with IC and 6 controls. We detected the protein expression of occludin and ZO-1 by immunoblotting, i m m u n o h i s t o c h e m i c a l s t a i n i n g a n d d o u b l e immunofluorescent staining with confocal laser scanning microscopy. Data were analyzed using Student s t-test.

Results:
The decreased expressions of occludin and ZO-1 in the IC group compared to the control group by immunoblotting and immunohistochemical staining. Immunofluorescent analysis showed that the expressions of these two proteins were discontinuous and looser in the epithelial layer than the control group.
Conclusion:Our data showed that decreased expressions of tight junction proteins (occludin and ZO-1) may lose the normal barrier function and change the epithelial permeability of urinary bladder in patients with IC.

Hospital (Taiwan)
Purpose: Fournier s gangrene is a life-threatening necrotizing fasciitis of the male genitourinary. This study was conducted to assess and predict the risk factors of mortality in Fournier s gangrene.

Materials and methods:
From 2000 and 2009, a total of 42 patients diagnosed as Fournier s gangrene were enrolled in this study. All of the patients received aggressive debridement and intensive care. Clinical characteristics and laboratory data were collected and systemically reviewed. The factors investigated were age, BMI, initial vital signs, complete blood count, sugar, renal function, liver function, electrolyte, CRP level, underlying disease and social history. The patients were subdivided into survival and nonsurvival group, and the impact of risk factors on survival was assessed between the two groups. The Fournier's Gangrene Severity Index (FGSI) was used to test the feasibility of FGSI predictive value in our patients.

Results:
Of the 42 patients enrolled, 35 patients were successfully treated and discharged, 7 patients died of the disease with mortality rate of 17%. The factors significantly associated with mortality were patients with DM, HBV, HCV, liver cirrhosis, ESRD, low hemoglobin level and elevated creatinine level. The predictive value of FGSI was limited in our series. A revised FGSI for Asian people was developed based on our results.

Conclusion:
Our results suggest that DM, liver and renal function impairment and low hemoglobin levels on admission are significant factors in assessing the mortality in patients with Fournier s gangrene. Identification of patients at risk for mortality early in the course of Fournier's gangrene may improve the patient management.

Hospital (Taiwan)
Herpes simplex infection is a common disease, but herpes simplex lymphadenitis is an extremely rare one. Review the literature, till present, less than thirty cases were reported worldwide. Up to 52% of the patients with lymphadenitis were in immunocompromised status. We presented one case of painful inguinal herpes simplex lymphadenitis in a young and obviously immunocompetent male. The inguinal lymphadenitis on sonography image was a lobulated cystic lesion with heterogenous echogenicity, mimicking abscess formation. Debridement was performed. The section tissue on microscopy showed necrotizing inflammation Purpose: Diabetes mellitus (DM) is more prevalent and causes much major morbidity to human beings world widely. Previously studies have been shown that hypogonadism is associated with type II DM in men, which is because of pancreatic islet -cells dysfunction. A lot of environmental pollutants, such as heavy metals, pesticides and other toxicants, have been found to harm hormonal systems, including pancreas and testes. Besides, many cross-sectional studies have found that 20 to 64% of male diabetic patients have hypogonadism. However, there are no studies to discuss the distinct relationship between pancreatic islet -cells dysfunction and hypogonadism. Therefore, we are going to investigate the mechanisms of hypogonadism-induced pancreatic islet -cells dysfunction and the restoration of pancreatic islet -cells function after testosterone replacement in vivo.

Materials and methods:
In this study, hypogonadism were induced by bilateral orchiectomy in animal model. All the animals were divided to 3 groups, namely control group, orchiectomy group, and group of orchiectomy combined with testosterone replacement. Sequential oral glucose tolerance tests, plasma insulin levels, and free testosterone concentration were harvested to analyze the relationship between testosterone and pancreatic islet -cells function in vivo. The hematoxylin & eosin stains for pancreatic islets were used for histological analyses. Testosterone was injected into orchiectomied animals to see whether the pancreatic islet -cells dysfunction was reversible or not.

Results:
The plasma free testosterone concentrations were reduced in the orchiectomy group, but were restored in the group of orchiectomy combined with testosterone replacement. The oral glucose tolerance tests showed that the orchiectomied animals increased their blood glucose levels and decreased their plasma insulin secretion. Both of these effects could be reversed by testosterone replacement. The histological findings of pancreatic islets were not significantly different in all groups. These findings explain that the pancreatic islet -cells dysfunction by hypogonadism is at functional level.

Conclusion:
Our results indicate that orchiectomy disrupts the pancreatic islet -cells function. By replacement of testosterone, the physiological functions of the pancreatic islet -cells can be preserved and the progression of DM may be avoidable.

MP28-22
200-W high-intensity diode laser in combination with transurethral resection of prostate in the treatment of benign prostatic hyperplasia with prostate volume more than 80 ml Chien-Hsu Chen 1,2 , Po-Hui Chiang 1,2 , Chun-Chien Hsu 1,2 , Yao-Chi Chuang 1,2 , Wei-Ching Lee 1,2 , Yen-Ta Chen 1,2 , Wei-Chia Lee 1,2 , Chih-Hsiung Kang 1,2 , Hung-Jen Wang 1,2 , Shu-Fen Tseng Purpose: To compare the efficacy and safety of 200-W high intensity diode laser in combination with transurethral resection of the prostate (TURP) and simple TURP in the treatment of benign prostatic hyperplasia (BPH) with prostate volume larger than 80 ml. From Jan. 2008to Mar. 2010 patients with lower urinary tract symptoms secondary to BPH with large prostate more than 80 ml underwent diode laser prostatectomy combined with TURP. Another, 36 patients with enlarged prostate over 80ml underwent TURP. The preoperative and follow-up functional parameters, such as International Prostate Symptom Score (IPSS), postvoid residual urine (PVR), and maximum flow rate (Qmax), were recorded. The operative data, peri-and postoperative complications were also recorded.

Results:
The demographic data were similar between the two groups. Preoperative prostate volume was 110.7 ± 28.9 ml in the diode laser combined with TURP group and 103.7 ± 31.2 ml in the TURP group. TURP group had significant shorter operation time; however, the catheterization time and hospital stay were in favor of the combined group. 3 patients in TURP needed blood transfusions due to significant blood loss but none in combined group. Postoperative bladder tamponade, requiring evacuation of blood clots, was more common in TURP group. There was no significant difference in terms of recatheterization rate and secondary TURP between the two groups. Both groups could achieve significant improvement in functional outcome during the follow-up period.

Conclusion:
With regard to operative safety and functional result, 200-W diode laser combined with TURP is feasible for BPH treatment with huge prostate.

PP30-7
Bilateral pneumo-nephroureter in emphysematous cystitisa case report Purpose: To report a case of emphysematous cystitis with rare bilateral pneumo-nephroureter and management.
Case report: A 53 years old female was admitted for evaluation of lower abdominal pain and painful urination. The laboratory data showed high serum blood sugar (>500 mg/dl), and elevated C-reactive protein (>20 mg/l). A urinary bacterial culture was collected. Plain X-ray film and computed tomography were done to demonstrate bilateral pneumo-nephroureter. She received cephalosporin and metronidazole to control infection, urethral Foley for drainage and anti-diabetic medications. Her hospital course was smooth. The bacterial culture showed Escherichia coli. Then the urethral Foley was removed after 3 days. The patient was discharged with oral antibiotics and anti-diabetic medications.
old cerebral vesicular accident, benign prostatic hyperplasia, hypertension, urinary tract infection. He was admitted to LMD due to septic shock rule out urosepsis related. Due to septic shock acute on chronic renal failure happened after admission and he received transient hemodialysis. Peripheral arterial occlusive disease of left lower leg with gangrene was noted during admission and he received left above knee amputation thereafter. Sonography showed right hydronephrosis and he received transient percutaneous nephrostomy drainage, but further survey for right hydronephrosis was not performed. However, the patient became drowsy after left above knee amputation and family asked to transfer to our hospital for second opinion. Lab data showed leukocytosis, prerenal failure, hyponatremia, urine analysis showed RBC 5-10/HPF, WBC numerous/HPF, bacteria 3+/HPF, yeast 3+/HPF. Then he was admitted to our nephrology ward under the impression of urosepsis. Because conscious drowsy was found, neurologist was consulted. CT showed atrophy and multiple lacunar infarctions of bilateral ganglia and frontal lobes. EEG showed mildly diffuse cerebral dysfunction. Thereafter coffee ground substance was noted in NG tube, upper gastrointestinal bleeding was suspected. Panendoscopy showed candida esophagitis. Besides urine culture showed candida albicans 100x103 CFU/ml. Diflucan 100 mg qd were given. Besides echography showed mild right hydronephrosis and IVP showed decreased right renal function and faintly opacified right renal pelvis with obscured right psoas muscle shadow. Urologist was consulted for evaluation and abdominal CT was suggested. Abdominal CT showed right psoas muscle abscess with mild right hydronephrosis. Due to general conditions of the patient was not stable, aspiration of abscess was postponed. The general conditions were improved after antibiotics course with cefuroxime and diflucan, CT guided aspiration of right psoas muscle abscess was performed and 2 ml abscess was aspirated. The culture of pus showed candida albicans and diflucan was kept in use. Thereafter under the stable condition, he was discharged.

Conclusion:
Psoas muscle abscess is a rare disease. Psoas muscle abscess with hydronephrosis is a rarer condition. Psoas muscle abscess can be induced secondarily by urinary tract infection. Psoas muscle abscess induced by candida albicans is also rare. Due to lack of specific presentation, diagnosis may be delayed. So highly suspicion for the possibility of psoas abscess should be kept in mind and abdominal CT may be helpful. Adequate drainage and antibiotics may improve the survival rate. Besides, aggressive survey should be performed, if the cause of hydronephrosis is unknown.

PP30-9
A case of bilateral psoas abscess and lumber osteomyelitis due to recurrent salmonella infection Chien-Yuan Wang 1 , Chin-Ming Su 1 , Hsiu-Nan Tsai 1 , Wei-Che Weng 1 , Jene-Chung Chang 1 1 Division of Urology, Municipal United Hospital (Taiwan) Psoas abscess due to Salmonella species is a very rare complication . Many pathogens have been related the genesis of these focal infections but only a few cases of salmonella psoas abscess were reported . There are only a few reported cases of osteomyelitis due to salmonella in a patient without sickle cell disease. we present a case of bilateral salmonella psoas abscesses and lumbar osteomyelitis due to recurrent salmonella infection managed by medical treatment and bilateral percutaneous drainage of abscess. Nontyphoidal Salmonella are an important cause of foodborne infections worldwide. A serious complication of Salmonella bacteremia is the development of endovascular infection, It could be complicated by pneumonia, vertebral osteomyelitis, aortoenteric fistula and rarely psoas abscess. Its clinical presentation is often insidious that may delay the accurate diagnosis and treatment. In immunocompromised patients, its symptoms often become more vague. Our patient was a case of 76 years old man with diabetes mellitus, pul. TB and infective colitis. He had a recurrent salmonella bacteremia in a five-month period and admitted to medical ward three times. Due to persisted fever, back pain and salmonella bacteremia, he received abdominal CT. Bilateral psoas abscess extending to pelvic cavity and lumbar osteomyelitis was found. The patient received bilateral percutaneous pus drainage for two months and antibiotic treatment for three months. A repeat CT showed no more psoas abscess at the end of 7 months.

PP30-10
THe spontaneous rupture of a emphysematous prostatic abscess: a case report Chih-Chun Ke 1 , Jun Chen 1 , Hong-Jeng Yu 2 , Ho-Shiang Huang 2 1 Department of Urology, National Taiwan University Hospital (Yunlin, Taiwan) 2 Department of Urology, National Taiwan University Hospital (Taipei, Taiwan) Emphysematous prostatic abscess is a rare but nevertheless serious clinical condition with high morbidity and mortality. Namely, it is an inflammatory process associated with gas and abscess formation in the prostate gland. The treatment of choice is prompt abscess drainage with early antibiotic therapy.
Case report: We report a rare case of emphysematous prostatic abscess owing to Klebsiella pneumoniae in a 60-year-old man with diabetes mellitus and alcoholic liver cirrhosis. He was admitted due to urosepsis, septic shock with acute kidney injury and hypoxic respiratory failure. Computerized tomography revealed periurethral gas forming in the prostate gland. Due to the patient s poor general condition, surgical drainage was not performed. We successfully treated the patient with parenteral antimicrobial agents only. Spontaneous rupture of the emphysematous prostatic abscess has been confirmed with transrectal ultrasound (TRUS), urethrocystoscopy and computerized tomography. The patient was discharged without any voiding difficulty, and there were no urinary sequelae during 8 weeks of follow-up.

Conclusion:
Emphysematous prostatic abscess is a rare but potentially lethal occurrence. The mortality rate is more than 30% according to the reported literature. Computerized tomography can assist in making the diagnosis of emphysematous prostatic abscess. Definitive treatment is combined surgical drainage with the use of effective antibiotics. But in highly selective cases, it could be successfully treated with intensive care and parenteral antimicrobial agents.

MetroHarbor Hospital (Taiwan)
Psoas abscess is a rare condition that can present with nosspecific clinical symptoms. Its insidious onset and occult characteristics can cause diagnostic delays, resulting in high mortality and morbidity. The abundant blood supply of psoas muscle is believed to predispose it to hematogenous spread from occult infection sites. We report a case of primary psoas abscess with review of literature. A 66-year-old female had left loin to groin pain with mild fever off and on for 3 weeks. She had visited local clinic and Gynecology clinic for help, but in vain. She then visited our Urology clinic, where abdominal echo showed right hydronephrosis. Urinalysis: RBC 5-10/ HPF. Intravenous urography: nonvisualization of left ureter with mild hydronephrosi. She was admitted and left ureteroscopy with double-J stenting done. Left upper ureteral stiructre with tortuosity was noted. Fever off and on persisted afterwards, so abdominal CT scan was arranged and it revealed a heterogeneous mass of left psoas and retroperitoneum. Percutaneous biopsy and drainage were performed. Pathology showed only a few RBC. Debridement with open drainage was done and 80 ml. of pus was drained. Streptococcus viridians growth was found on pus culture and T.B. culture was negative. Ampicillin 2gm q6h was administered. She recovered well after 3 sessions of debridement and wet dressing of wound, and was discharged home after 6 weeks of hospitalization. Purpose: We treated a female patient with staghorn stone of her left kidney. This is the first reported coexistence of xanthogranulomatous pyelonephritis (XGPN) and Castleman s disease (CD). We report the case and the findings and review related literature.

Materials and methods:
A 54-year-old woman was referred to our clinic after failed extracoporeal shockwave (ESWL) therapies for her known left renal stone. She suffered left flank dull pain, dysuria and chillness after the ESWL. Renal ultrasonography demonstrated left staghorn stone and chronic hydronephrosis with thin cortex thickness. The DMSA scan showed differential function of 6.6% only on the left kidney. Left nephrectomy was performed after detailed discussion with her and her family.

Results:
The left kidney was enlarged (>20cm in length) on exploration and the perirenal tissues showed marked adhesion. There was about 500cc frank pus accumulated within left renal pelvis area and a 5.8cm complete staghorn stone impacted over the ureteropelvic junction. The left kidney and upper ureter were resected smoothly. The patient recovered well and was discharged one week after nephrectomy. The pathology revealed xanthogranulomatous inflammation and interstitial / perirenal fibrosis which indicates XGPN; and prominent germinal centers and dense plasma cell infiltrates suggestive of Castleman s disease.

Conclusion:
Our case report showed that XGPN and CD may occur together as a result of chronic inflammation related to obstructive urolithiasis.

PP30-13
Emphysematous cystitis onset after common bile duct stone surgery-case report Emphysematous cystitis is a potentially fatal disease if the treatment is delayed. A high index of suspicion is crucial for early diagnosis of the disorder, which typically occurs in patients with poorly controlled diabetes. Though gas in urinary bladder is suggestive of emphysematous cystitis, other differential diagnosis includes postoperative states, enterovesical fistula, and urologic instrumentation. We report a case of emphysematous cystitis in a 73 years old female diabetic patient, who had undergone a major surgery for an obstructive common bile duct stone prior to the onset of emphysematous cystitis. A Foley catheter was indwelled during the surgery, and was removed soon after the surgery. She was later discharged smoothly from the hospital with a percutaneous T-tube for postoperative drainage of the bile. Three weeks later, she presented with septic shock that was accompanied by mild abdominal pain with tenderness, dysuria, urinary retention, and fever. There was turbid bile drainage from the T-tube, and biliary tract infection was suspected. Laboratory data showed leukocytosis, elevated serum amylase, lipase, alkaline phosphatase, and glucose up to 351mg/dl. Urinalysis revealed significant pyuria, hematuria, proteinuria and glucosuria. An abdominal computed tomography detected extensive gas formation within the bladder lumen as well as within the bladder wall and confirmed the diagnosis of emphysematous cystitis. Urine culture and blood culture yielded Klebsiella pneumonia. The bile culture was sterile, however. She responded well to prompt antibiotics therapy, adequate drainage of the urinary tract as well as the biliary tract, and good glycemia control. She was discharged at hospital day 7 and remained stable at the 3-month follow-up period.

Urine retention caused by mass fungal colonies-an unusual case report
Meng-yeh Lin 1 1 Division of Urology, Department of Surgery, Cheng-Ching General Hospital (Taiwan) Cystitis caused by Candida species occurs in about 2% of urinary tract infection. Fungi are typically opportunistic pathogens in a host with compromised immune function. Occasionally, large colonies of fungi can produce obstruction of urinary tract. Herein, we report a case of urine retention caused by mass fungi colonies. Because of dysuria for more than 1 week and whitish materials in urine for 2 days, this 52 year-old man came to our OPD for help. Abdominal echo showed multiple linear bright lesions in distended bladder. Acute urine retention happened after admission. Although Foley was inserted, Foley tube was occluded by the white materials. After emergent cystoscopy, mass white materials were evacuated. The white materials were proved as Candida albicans by pathological examination.

Memorial Hospital (Taiwan)
Purpose: To provide real data about emphesematous pyelonephritis in Taiwan.

Materials and methods:
Retrospectively studied patients with EPN in our hospital in a decade.

Results:
Total 11 cases met the image finding of emphesematous pyelonephritis. 7 caes were female whrease 4 were male. 3 cases underwent nephrectomy however all survived. 10 cases were diabetic.The only mortality case was a recipient after kidney transplantation, with infectious graft kidney, without diabetes. The culture result showed E.coli in 9 cases, dominantly. Percutaneous pigtail drainge of the infection kidney was performed in 9 cases. Only one case underwent nephrectomy emergently for uncontrolled infection.

Conclusion:
Emphysematous Pyelonephritis is an uncommon, life threatening necrotizing infection of renal parenchyma with gas formation.However, early diagnosis and drainge tube placement may still benifitial for infection control.

Materials and methods:
An 81-year-old woman was diagnosed with emphysematous cystitis by computed tomographic scan of the abdomen.

Results:
Cystoscopic examination was performed after she was treated by intravenous antibiotics. The cystoscopy showed no air or bulla inside the urinary bladder; moreover, the mucosa was "tattooed"with wide-spread, flat, and circular erythematous wheels.

Conclusion:
The specific picture on mucosa of bladder; as well as in"skin target lesions", that provide a different manifestation whether in the morphology or in the pathogenesis by disease itself or organisms. Tuberculosis (TB) of the epididymis accounts for about 20% of genitourinary TB. Mycobacterium tuberculosis, the infecting microorganism reaches the genitourinary organs by the hematogenous route from the lungs. It is postulated that TB epididymitis is almost always from a descending infection of the prostate. This condition is a slow process and usually there is no pain. We report a case of a 20 yearold male patient presented to our clinic with a painless nodule over his right hemiscrotum. Complete blood count, biochemistry, alpha-feto protein and beta-human chorionic gonadotropin were all within normal levels. Chest x-rays was clear and computed tomography scan of the pelvis showed a tumor of the right testis involving the epididymis. A right radical orchiectomy was arranged, however, on the day of operation, patient claims of severe pain with associated local warm and redness of the scrotal skin. Scrotal ultasonography performed and shows a hypoechoic lesion with internal debris over the right epididymis. An open debridement was performed and revealed an abscess with caseous-like necrotic tissues. Postoperative pathology showed tuberculosis epididymitis with abscess formation. Postoperative pathology showed tuberculosis epididymitis with abscess formation. Subsequent culture of the pus yield Mycobacterium tuberculosis. He had an uneventful postoperative course, at present is being treated with triple anti-tuberculosis medications for 9 months and is in stable condition.

Fulminant emphysematous pyeloneprhitis (EPN) managed by percutaneous drainage (PCD): a case series
Yi Chiu 1 , Kenneth Fu 1 1 Queen Elizabeth Hospital (Hong Kong) Purpose: Emphysematous pyelonephritis is a rare, severe gas-forming infection of the kidney resulted in high operative mortality. Newer literatures suggested percutaneous drainage, as compared to the standard nephrectomy, as a better modality. We reported three cases of EPN in 2008-2010, which were successfully managed by combined PCD and medical treatment.

Materials and methods:
Three ladies with median age of 61 (58-66) were admitted to Queen Elizabeth Hospital for loin pain and fever. All of them developed urosepsis with shock requiring ICU admission. Computer Topography showed emphysematous pyelonephritis. (one Class I, one Class 3A, one Class 3B, Huang model) Emergency percutaneous drainage by either radiologist or urologist was performed.
Results: 1.Case of Class 3B emphysematous pyelonephritis had a Fr 10 Flexima drain inserted by a radiologist to the retroperitoneal space. Along with medical treatment in ICU, her condition improved. Follow-up CT scan at 4th week showing resolving gas pockets. Another follow-up CT scan at 16th week showing complete resolution of gas pockets and the catheter was removed. At the latest follow-up at 15th month, she had fully recovered with a normal renal function. 2.Case of Class 3A emphysematous pyelonephritis was further complicated with acute myocardial infarction. Emergency drainage under general anaesthesia was performed by a urologist and a urology trainee. Three 10 Fr Malecot catheters were inserted to the perinephric space. Along with medical treatment in ICU, her condition improved. Follow-up CT scan at 1st week reported 3 catheters in situ. All Malecot catheters were removed on post-op Day 11. CT at 6th and 16th week reported decreased size of left kidney collections. Complete resolution of renal collection was reported on CT at 10th month. Upon the latest follow-up at 11th month, she had fully recovered with a normal renal function. 3.Case of Class 1 emphysematous pyelonephritis had a Fr 14 malecot catheter inserted by a urologist and urology trainee under LA to the collecting system. Along with medical treatment in ICU, her condition improved. Follow-up CT scan at 3rd week showing resolution of gas pockets and an obstructing ureteric stone. Ureterosocpic lithotripsy was performed at 4th week with stone clearance. A ureteric stent was inserted and the percutaneous drain removed. Upon the latest follow-up, she had fully recovered with a normal renal function.

Conclusion:
Emphysematous pyelonephritis is a urological emergency. Patients are usually diabetic middle aged ladies presented with urosepsis and septic shock. Previous gold standard of treatment was emergency nephrectomy. However risk of major surgery is high for this group of patients. Hence, with the advances of percutaneous access, percutaneous drainage becomes the new gold standard of management of emphysematous pyelonephritis. In conclusion, with the advance of image guided drainage, percutaneous drainage should be the new gold standard for the management of emphysematous pyelonephritis.

PP30-19
Prevalence and risk factors of extended spectrum beta-lactamase producing uropathogens in patients with urinary tract infection Purpose: The aim of this study is to determine the prevalence and risk factors of extended spectrum betalactamase (ESBL) producing microorganisms in urinary tract infection.

Materials and methods:
A total of 2,312 patients older than 25 years and diagnosed as urinary tract infection from January 2007 to December 2009 were involved. The prevalence of ESBL producing microorganisms including E. coli and antimicrobial susceptibility of E. coli were examined. Univariate analyses were performed with gender, age, inpatient, previous hospitalization, the recent history of urinary catheterization, the recent exposure to specific antibiotics and past history of urogenital organ operation as risk factors of emergence of ESBL producing microorganisms. Then, multivariate analysis was performed with all significant variables.

Results:
In outpatient urinary tract infection, antimicrobial s u s c e p t i b i l i t y o f E . c o l i t o e a c h 3 r d g e n e r a t i o n cephalosporins, cefotaxime, ceftazidime and ceftriaxone was 87.6%, 93.4%, and 87.7% respectively and the prevalence of ESBL producing E. coli was 12.1%, whereas the susceptibility of E. coli was 78%, 84.5%, and 76.9% respectively and prevalence was 23.1% in inpatient urinary tract infection. The risk was appeared to be increased in cases with previous hospitalization, the recent history of urinary catheterization, inpatient, cefaclor medication, cefminox administration and female.

Conclusion:
To prevent the spread of multidrug resistant microorganisms, especially ESBL producing species in urinary tract infection, medical institutions should make efforts to develop administrative and educational programs and to provide the appropriate guidelines for the prescription of antibiotics as well as urinary catheter.

PP30-20
Dutasteride, a dual 5 -reductase inhibitor, suppresses angiogenesis via hypoxia-inducible factor 1 in prostate cancer cells Materials and methods: The modification of PAn (polyaniline) with succinic anhydride to form a water soluble self-doped poly[N-(1-one-butyric acid)]aniline (SPAnH) as a hydrophilic conducting polymer has been made to enhance its bio-applications. MNPs coating with a shell of SPAnH (SPAnH/MNPs) were prepared without using cross-linking agent, which show a very good environmental stability. The hydrophobic Taxol (antimicrotubule agent) was immobilized successfully on the surface of SPAnH/MNPs to form Taxol/SPAnH/MNPs and be guided with applied magnetic field to the target area and against the human prostate cancer cells.

Results:
In the in vitro cytotoxicity test, the SPAnH/MNPs did not exhibit any toxicity to prostate cancer cell line PC-3 and CWR22R up to 48 has compared with the control. But the bound Taxols did exhibit toxicity to the cells, and their cancer cell killing activities were dose-dependent against both PC-3 and CWR22R cells. In the case of 10μM free Taxol showed the cytotoxicities of about 75% and 59% of PC-3 and CWR22R cells, respectively, whereas those of bound Taxol are about 68% and 45%, respectively. It indicates that the inhibition of cell growth of bound Taxol was higher than that of free Taxol, which results from the better thermal stability and more effective drug treatment of bound Taxol than free Taxol at the incubation temperature of 37 . While the cells treated with bound Taxol under an applied magnetic field (800 Gauss), the surviving cells decrease down to 45% and 12% for PC-3 and CWR22R cells, respectively, indicating that most of the bound Taxols can be guided and concentrated on the target area effectively.

Conclusion:
A novel and nontoxic SPAnH/MNPs drug carrier which contains carboxyl acid group was successfully developed and can be used for the immobilization of hydrophobic drug, Taxol, effectively. The bound Taxol can be guided and concentrated at the tumor site by an applied magnetic field, enhancing the local concentration and therapeutic efficacy. This magnetic deliverable Taxol shows the potential for the development of new treatment of antitumor for human PCa.

PP30-23
The use of serum creatinine to monitor renal function in spina bifida patients The next issue to address is the use of estimated glomerular filtration rate, which is based on SCr, but also takes into consideration height and body weight in some of the formulae.

PP30-24
Zoledronic acid induces autophagic cell death in human prostate cancer cells Purpose: Bisphosphonates are potent inhibitors of bone resorption frequently used for breast cancer and myelomainduced done disease. Zoledronic acid (ZA) has been recently shown to also reduce skeletal morbidity from prostate cancer. In vitro studies also showed that ZA inhibit prostate cancer cell growth by activating caspase cascade which leading to apoptosis cell death. In this study, we investigate whether ZA also inhibit prostate cancer cell growth by type-II programmed cell death, autophagy.
Material and methods: MTT assay was introduce to investigate the biological effects of ZA on PC-3 and DU-145, androgen-independent human prostate cancer cell lines, as well as LNCaP and CRW22Rv1, androgensensitive cell lines. The formation of LC3-II protein, a marker protein involved in the formation of autophagosome during autophagic cell death, was detected by Western blot. Formation of acidic organelles was detected by acrindine orange staining. LC3-II incorporation into autophagosome was detected by Immunoflorescent (IF) staining.
Results: ZA exhibited dose and time-dependent growth inhibition on four human prostate cancer cell investigated. Apoptosis was demonstrated by caspase-3 activation. Autophagic cell death was detected by the formation of LC3-II protein as early as 24 hours exposure to 100nM of ZA. Acidic organelles were detectable by acridine orange staining and IF showed round-up and condensed staining of LC3-II, suggesting the formation of autophagosome in the cytoplasm during autophagic cell death. The rescue of cell growth occurred only by administration of both apoptosis and autophagy inhibitor during ZA treatment suggesting ZA induces prostate cancer death by either apoptosis or autophagic cell death.
Conclusion: This is the first study showed that ZA markedly inhibit human prostate cancer cells growth thought autoghagic cell death. ZA can exhibit its anticancer activity via both apoptosis and autophagy. These findings could potentially contribute to the beneficial effect of ZA in prostate cancer treatments.

PP30-25
Characterization of smooth muscle differentiation of purified human skeletal muscle derived cells time of the hMDCs and purified hMDCs are measured. The purified hMDCs are characterized by flow cytometry, immunofluorescence and confocal laser scanning microscopy.

Results:
The growth doubling time of hMDCs is approximately 24 hours which is increased to 35 hours after purifying by magnetic Dynabeads. There are scanty fibroblasts after the purification and the purified hMDCs are identified by high expression of stem cell markers and myoblast markers. The expression of proportion of stem cell marker CD34 and myoblast marker CD56 show increased when compared with the cells before Dynal CD34 cell selection (32.13 Vs. 4.12% and 21.56 Vs. 8.60%, respectively).

Conclusion:
The purification of hMDCs is feasible which show high expression of stem cell and myoblast markers. These purified hMDCs might be potential for urological regeneration.

Effects of botulinum toxin A on the contractile function of rabbit urethra
Yu-Hua Fan 1 , Alex T.L. Lin 1 , Kuang-Kuo Chen 1 1 Division of Urology, Department of Surgery, Taipei Veterans General Hospital, and Department of Urology, (Taiwan)

Purpose:
We used an animal model to explore the action mechanism of botulinum toxin A (BoNT/A) on the urethral contractile function.

Materials and methods:
Female New Zealand White rabbits (2.5-3.0 Kg) were used in this study. 30U BoNT/A in 1ml normal saline or 1ml normal saline was evenly injected to the urethra and bladder neck. 7 (N=6) and 14 (N=5) days later, the animals were scarified and the urethra was obtained. Contractile responses of urethra and bladder neck strips to field stimulation (1-128 Hz, 50 V, 1 ms), potassium chloride(120 mmol/l) and phenylephrine (10-8 to 10-3 mol/l) were tested in tissue bath.

Results:
One week after injection of 30U BoNT/A, contractile responses of urethra and bladder neck strips to potassium chloride, electrostimulation, and phenylephrine were not significantly different from those of sham group. However, two weeks after injection of 30 BoNT/A, contractile responses of urethra strips to higher frequency electrostimulation (32-128 Hz) were significantly reduced. Contractile responses of urethra strips to phenylephrine and potassium chloride were not different from sham group two weeks after BoNT/A injection. Contractile responses of bladder neck strips to 1 Hz electrostimulation were significantly reduced two weeks after BoNT/A injection but other parameters of bladder neck strips were not different from sham group.
Conclusion: Inhibitory effects of BoNT/A injection on electrostimulation-mediated contractions but not on phenylephrine-induced contractions in rabbit urethra suggests that the effect of BoNT/A on relaxing the urethra may come from the inhibition of excitatory neurotransmitter release from presynaptic nerve endings.

School of Medicine (United States)
Purpose: Transforming growth factor beta (TGF-) is known to suppress benign cells but promote tumor progression. The objective of this study is to determine whether or not TGF-1 signaling acts differentially on benign and malignant prostate epithelial cells.

Materials and methods:
Malignant (PC3, DU145) and benign (RWPE1, BPH1) prostate epithelial cell lines were used. Erk activation was measure by phosphorylation of Erk using Western blotting. TGF-1 signaling was blocked either by neutralizing TGF-antibody (1D11) or by introducing a dominant negative TGF-type II receptor (T RIIDN) vector.
Results: At a low dose, all cells showed a rapid activation of ERK. At a high dose, malignant cells continued to display a rapid activation of ERK, but benign cells showed a transient inactivation of ERK. The serine/threonine phosphatase activity increased in a dose related manner in benign cells, but not in malignant cells. This phenomenon was consistent with the ability of TBRI to recruit PP2A-B in benign cells but not in malignant cells. Inhibition of PP2A by okadaic acid (10 nM) in benign cells resulted in an immediate activation ERK and autoinduction of TGF-1 following the high dose of TGF-1.

Conclusion:
In benign cells, recruitment of PP2A-B by T RI provided a mechanism to terminate Erk activation at a high dose of TGF-. However, in malignant cells, there is a runaway of TGF-1 mediated Erk activation due to a defective recruitment of PP2A-B by T RI.

PP30-30
The effect of hyperglycemia on intracavernous pressure after electrical stimulation of cavernous nerve in the diabetic rat

Materials and methods:
Male adult Sprague-Dawley rats (200-250 g) were used. Intraperitoneal injection of streptozotocin (STZ) 60 mg/kg was done to induce diabetes mellitus in the rats. Rats without injection of STZ were used as a control. Venous blood sampling for blood glucose determination was done in STZ group and control group of rats three days, and four and eight weeks later to ascertain A351 the hyperglycemic status in the STZ group. Only rats with blood glucose levels of greater than 300 mg/dl 3 days after STZ injection were used. A 26-gauge needle was inserted into the corpus cavernosum of the rats with and without hyperglycemia (blood glucose > 300 mg/dl) to monitor the ICP. The CN was identified and was electrically stimulated with the parameters (1, 2.5, 5, 7.5, 10 V, 20 Hz, 2 ms, 1 minute). The ICP before and after electrical stimulation of CN was compared by Wilcoxon sign rank test, respectively. The amount of ICP increase (peak ICP minus resting ICP) after electrical stimulation of CN between groups was compared by Mann-Whitney U test, respectively.
Results: There was a significant increase of ICP after CN stimulation with each of the stimulus parameters (from 5.4±1.2mmHg to 49.6±4.7mmHg in 4-week STZ group, from 6.0 ±2.0mmHg to 51.3±12.3 mmHg in 8-week STZ group, and from 8.4±1.9mmHg to 74.8 ± 9.0mmHg in control group; electrically stimulated with 5V respectively). There was a trend of less amount of ICP increase after CN stimulation with parameter 5V in the 4-week STZ group as compared with control group (44.2±4.9mmHg, 4-week STZ group vs. 66.4 ± 8.1 mmHg, control group, p=0.056; 45.3±12.3 mmHg, 8-week STZ group vs. 66.4±8.1 mmHg, control group, p=0.250; electrically stimulated with 5V respectively). There was no significant difference of amount of ICP increase between the 4-week STZ and 8-week STZ diabetic rats (p=1.00) electrically stimulated with parameter of 5V. The blood glucose level was greater than 300 mg/dl in all rats 3 days, 4 and 8 weeks after STZ injection.

Conclusion:
The results suggest that a significant increase of ICP after electrical stimulation of cavernous nerve is noted in the diabetic and control groups of rats. The amount of ICP increase after CN stimulation is less in 4-week-STZ and 8-week STZ diabetic rats than that in control group. However, there is only a trend of less amount of ICP increase after CN stimulation with parameter 5V in the 4-week STZ group as compared with control group. After electrical stimulation of CN, no significant difference of the amount of ICP increase is noted between the 4-week STZ and 8-week STZ diabetic rats. significant differences in the maintenance flow at ICP 90mmHg (p = 0.016), Tmax (p =0.016), Vmax (p=0.016), and pressure loss (p=0.016). In cadaveric penises, after the removal of erection-related veins a rigid erection could be maintained in spite of the fact that the low flow rate of 5.5-8.0 ml/min colloid, is much lower than the average arterial perfusion rate observed in cases of arterial insufficiency.

Conclusion:
We, therefore, concluded that penile vein is categorically the determinant in penile erection since none of the current contributors of penile erection can be expressed in cadavers such as intracavernosal, hormonal, arterial, neurological, drugs effect, chronic systemic diseases, and psychogenic factors.

Clinical significance of CD14 expression in the urine of BPH patient
Hong-Lin Cheng 2 , Hung-Jen Huang 1 , Bing-Yuan Ou 1 , Shu-Hui Chen 1 , Nan-Haw Chow 3 Inclusion criteria: BPH patients were defined as prostate volume more than 30 ml (gm) and with total symptoms scores greater than 12; healthy subjects were less than 30 ml (gm) in prostate volume and with symptoms scores less than 12. Prostate volumes were measured by transrectal ultrasound. The symptoms scores was evaluated by international prostate symptoms scores (IPSS) from score 0 to score 35. Exclusion criteria were medical diseases such as DM and renal failure, and urinary tract infection by routine urinary analysis. Spot urine was collected after informed consent signature. Conclusion: From this study, CD14 expression in the urine could be a marker associated with BPH. However, the mechanism remains to be studied.

PP30-33
The role of chloride channels on rat bladder smooth muscle A353 penile smooth muscle tone. Recent study revealed increased expression of ClCa channels in detrusor overactivity myocytes. We conducted this experiment to evaluate the role of chloride channels on rat bladder smooth muscle.
Materials and methods: 12-14 week old adult Whistar rats were used for this study. After appropriate anesthesia, the bladder smooth muscle tissue were harvested, cut into 3x3mm rings and mounted in individual 25-ml isolated organ bath chambers. Isometric contractions of the bladder smooth muscle rings were conducted by adding different agents into the chambers. Various studies included 1) Dose response curve of agonists: NE, KCl, 2) Dose response curve of alteration of ECl and substitution of Cl-by Br-, I-, 3) Inhibitory dose response curve of Cl-transport inhibitors: BUM (bumetanide), HEPES without bicarbonate, ETH (ethacrynic acid), 4) Inhibitory dose response curve of Clchannel blockers: DIDS, A-9-C (anthracene-9-carboxylic acid), Niflumic acid.
Results: 1) Dose response curve of agonists: Both NE and KCl could achieve dose-dependent contraction on rat corpus cavernous tissue strips. 2) Dose response curve of alteration of ECl and substitution of Cl-by Br-, I-: there is no significant change of NE-induced contraction with different ECl; however, the contractions of NE decrease when the extracellular Cl-is substituted by Br-,and I-. 3) Inhibitory dose response curve of Cl-transport inhibitors: all the Cl-transport inhibitors could inhibit the NE-induced contraction significantly. 4) Inhibitory dose response curve of Cl-channel blockers: all the Cl-channel blockers can inhibit the NE-induced contraction significantly.

Conclusion:
This study demonstrate that interference with either the distribution of chloride across the membrane or the ability of chloride channels to open markedly suppresses contractile responses of rat corpus cavernous smooth muscle to norepinephrine. This result implies in advance that chloride channels are of functional importance in the regulation of bladder smooth muscle tone. Purpose: Alpha1 adenoceptors antagonists (doxazosin, terazosin, prazosin) are commonly prescribed drugs for benign prostate hyperplasia and hypertension. Doxazosin and terazosin but not tamsulosin also exhibit antiangiogenic effects and apoptotic activities against multiple cell types via a distinct mechanism and are potential preventative agents for prostate cancer. Prazosin induces apoptosis in 3 prostate cancer cell lines. We hypothesized that prazosin, a more potent alpha1 adenoceptor antagonist with a distinct mechanism, exhibits anti-angiogenic activity.

Materials and methods:
We examined prazosin s effect on growth and tube formation of human umbilical vascular endothelial cells (HUVEC). The effect of prazosin on cell cycle progression was assessed using propidium iodide staining and flow cytometry. Its effects on expression of various apoptotic proteins were revealed using Western blot. Cell adhesion and tube formation assays were also examined.
Results: Prazosin inhibited the growth of HUVEC with an IC50 of 6.53μM and suppressed tube formation in a dose dependent manner. In contrast to treatment of prostate cancer cells, prazosin did not arrest the cell cycle progression at G2/M checkpoint. Prazosin (20μM) treatment induced a loss of mitochondrial membrane potential by 12 hours as detected by rhodamine 123 staining. Prazosin treatment of HUVEC also reduced MCL-1 expression, increased Bad, and Bcl-XL expression, induced release of cytochrome C, and induced apoptosis via the intrinsic apoptosis pathway.

Conclusion:
Prazosin exhibited several differences in the mechanism of apoptosis between prostate cancer cells and normal HUVEC cells. These studies suggest that prazosin exhibits anti-angiogenic activity and differentially A355 786-O and A498 with different status of VHL or HIF transactivity were used to examine the JunB expression and invasive ability. The subclones stable transfected with wild-type JunB and JunB shRNA were injected into the flank of nude mice to assess the effect for tumor growth and angiogenesis in vivo.

Results:
We first observed that invasive ability was regulated in a HIF-independent manner and that it was associated with JunB expression. Next, pharmacological inhibition of aPKC suppressed both JunB expression and the invasive ability of these cells, indicating that JunB may affect invasive ability. Specific suppression of JunB by shRNA in VHL-defective ccRCC cells reduced invasive ability in vitro, and tumor growth and angiogenesis in vivo. Conversely, overexpression of JunB in VHL wild 786-O subclone promoted invasive ability in vitro, and tumor growth and angiogenesis in vivo. Furthermore, investigation of downstream effecters of JunB by PCR Arrays revealed that JunB regulated several genes related to invasion and angiogenesis such as MMP-2, MMP-9, and CCL2.

Conclusion:
These observations clarify that JunB regulates invasive ability and angiogenesis in VHL-defective ccRCC. Therefore, we suggest that JunB can be a possible target for the prevention of invasion, metastasis, and angiogenesis in VHL-defective ccRCC. neurotransmission in the voiding contraction of detrusor muscle of the bladder, by characterising the evoked contraction in mouse detrusor smooth muscle.

Materials and methods:
The effects of an nNOS inhibitor, 7-nitro indazole (7-NI) and an purinergic desensitizer, , -Methylene ATP, on the evoked contractility were explored using mouse detrusor strips and whole bladders.
In vivo urodynamic studies were performed on female mice to determine the effects of another nNOS inhibitor, SMTC, on the bladder function. urodynamic studies showed that low dose of SMTC (0.3 mg.kg-1) significantly increased the voiding interval (SMTC vs. control; 373 ± 38 s vs. 335±44 s, na=6, P < 0.01) and slightly increased the bladder capacity (120±9μl vs. 110±12μl, P = 0.08) in female mice, while no significant changes were found in blood pressure (105±6 cmH2O vs.

Results
109±3 cmH2O, P=0.6). Purpose: Human Papilloma Virus (HPV) has a proven role for genesis of genital tumors, but its association with TCC of urinary bladder is not clear. High-risk Human HPV types stimulate degradation and deactivation of protein associated with the p53 tumor suppressor gene via the ubiquitin-dependent pathway. Dysregulation of p53 gene in transitional cell carcinoma of urinary bladder has been associated with poor clinical outcome. A few studies have documented concurrent HPV positivity and abnormal p53 expression. We carried out the study to assess frequency of p53 gene mutation, prevalence of HPV infection in patients with TCC of urinary bladder and to find out its correlation with standard histological parameter.

Materials and methods:
Tumor tissue sample of 50 patients with histologically proven TCC of urinary bladder obtained by trans urethral resection or radical cystectomy were examined. P53 mutation was assessed by DNA isolation and PCR -SSCP (polymerase chain reactionsingle strand conformation polymorphism) analysis. PCR was used to detect HPV DNA (type 16 and 18). Data were analyzed by Fischer s two tailed t tests and Pearson s chi square test using SPSS 15 statistical software.
Conclusion: P53 mutation is associated with aggressive behavior and patients need to be followed up closely. None of the patients in our study showed presence of HPV DNA and therefore unlikely to be the cause of bladder TCC.

PP30-40
Effects of human chorionic gonadotropine on normal testicular tissue in rats Purpose: In this study, we have investigated the histologic effects of HCG therapy on descended testes of rats and their reversibility and dose dependency.

Ma t er ia ls a n d m et h o d s :
F o u r ty m a l e r a t s w e r e randomized in 4 groups receiving HCG in doses of 15IU/ kg, 30IU/kg, and 60IU/kg , the last one group receiving isotonic saline. The injections were performed once daily via the subcutaneous rout for 15 days. Changes in the serum testosterone were studied in the specified times. One month after finishing injections, 5 rats of each group were killed; the remaining 5 rats in each group were also killed after 3 months and their right testicles were removed to be evaluated.

Results:
One day after completing injections, the rates of the serum testosterone increased considerably. But in the third day, these rates decreased intensively, reached in a normal amount and after that time, there was no significant increase. One month later, there was no significant difference between the HCG groups and the control group regarding the mean thickness and the number of the cell layers of the germinal membrane, the mean diameter and the percent of open seminiferous tubule and the ratio of the germ cell to spermatogonia. Three months later, again, there were no significant differences in these measures between the HCG groups and the control group. But when the mean of these measures after one month were compared with that of after three months the mean thickness and the number of cell layers of the germinal membrane, the diameter of the seminiferous tubule and the ratio of the germ cell to spermatogonia had a considerable decrease and the percent of open semineferous tubule showed a significant increase.
Conclusion: HCG impairs seminiferous tubule histology in the normal descended testes of rats. This effect was dosedependent and the changes were reversed at 3 months after treatment.

PP30-41
Simvastatin attenuation nuclear factor-Kappa activation and decrease oxidative stress induced by testicular torsiondetorsion symptoms before and after 20 weeks leuprolide acetate treatment.

Results:
The prostate size was decreased by 29.5(26-35)% and mean residual urine volume was 62(39-115)ml after treatment. The patients tolerated the treatment even if they had side effects such as loss of energy, flushing and decreased sexual function. Quality of life score due to urinary symptoms before treatment was 6(terrible). After 20 week treatment, the score was decreased by 2(mostly satisfied) or 3(equally satisfied and dissatisfied). Average score was 2.6. In spite of discontinuation of leuprolide acetate, their urinary condition was preserved with alpha recepter bloker and finasteride, and all the patients were not needed cystostomy catheter any more.

Conclusion:
Short term (20 weeks) therapy of leuprolide acetate for severe BPH patients who do not want continuous cystostomy and who are poor surgical risk improved quality of life score due to urinary symptoms.

PP30-44
Development of a novel molecular therapeutic target for advanced renal cell carcinoma (RCC) the bladder mucosa contains a group of four related transmembrane proteins, the uroplakins (UPs; UP Ia, UP Ib, UP II, and UP III), which together with tight junctions, form a specialized membrane compartment that represents one of the tightest and most impermeable barriers in the body. The down-regulation or destruction of UPs may increase the permeability of the bladder, permitting increased access of the toxic materials in the urine to the neurons, and consequently accumulating inflammatory cells in the mucosa or submucosa. We investigated the protective mechanisms of mesna in the expression of uroplakin (UP) in CP-induced rat cystitis.

Materials and methods:
A total of 54 Sprague-Dawley (SD) female rats with body weights of 230-250 gm received a single intraperitoneal injection of 200 mg of CP/kg. Six CP-treated, 6 CP + mesna (120 mg/kg)-treated rats, and 6 negative controls were sequentially sacrificed at 12, 24, and 72 hrs post-CP injection. The bladders were harvested, and then cut into three equal pieces from the dome to the base for real-time PCR, western blotting, and immunohistochemical staining. To obtain constructs for controls (pUP_Ia, pUP_Ib, pUP_II, pUP_III, and p -actin) to quantify the UPs and -actin mRNA, partial cDNAs were amplified from a rat urinary bladder sample using UPs and -actin primers, and then cloned into pGEM-T Easy vector. Calibration curves were made from the measured fluorescence of dilution series of the control plasmids. Then, the concentrations of unknowns from the specimen were calculated from standards values. The western blotting was performed with goat polyclonal primary antibody (anti-UP II and III), and the immunolabeling with anti-UP II polyclonal antibody.
Results: Linear relationships of all control plasmids from 100 to 10-6 starting copies revealed a strong correlation between the copy number and the cycle threshold (Ct) values. The levels of UPIa, Ib, II, and III mRNA on realtime PCR, the UPII and III expressions on immunoblotting, and the UPII expression on immunolocalization study in the harvested bladder were maximally suppressed within 12-24hrs, whereas partially or completely recovered at 24-72hrs post-CP injection. In addition, the responses in UPs after a CP insult were heterogeneous (i.e., markedly suppressed in UPII and lesser destructive in UPIII). Even though the mesna-treated rats also showed transient and small reductions in the mRNA levels of all UPs, mesna clearly preserved the UP expressions of mRNA and protein in CP-induced urinary bladder mucosa.

Conclusion:
This study suggests that CP transiently reduces the expression of UPs and mesna protects the urinary bladder mucosa through the preservation of UPs protein. Again, our study indicated that mesna defended the toxicity from CP in the urinary bladder relatively well. However, our study also revealed that mesna treatment did not completely preserve the expression of UPs in a CPinduced cystitis rat model.

PP30-46
The effects of intermittent pneumatic compression system and elastic bandage compression of deep vein thrombosis prevention in urologic patient with lithotomy position.
Shu-Fan Tasi 1 , Pei-Yi Lu 1 , Chao-Ren Chang 2 1 Nursing specialist,Department of Nursing,Kaohsiung Veterans General Hospital (Taiwan) 2 Division of Urology Surgery,Department of Surgery,Yu-Li Veteran Hospital (Taiwan) Introduction: During urologic surgery, most patients were put in lithotomy position. Previous research showed that about 50% deep vein thrombosis (DVT) developed during operation, and its incidence reached highest at operative day and post-operative day 1. DVT might cause occlusion of leg vessels, accompanied with pain and swelling. To provide adequate prevention and protection of DVT, this article compared the effect between intermittent pneumatic compression system (IPCS) and elastic bandage compression (EBC) Purpose: Elastic bandage compression is a common method to prevent deep vein thrombosis and leg edema during operation. The cost of intermittent pneumatic compression system is much higher. This study is to compare the clinical efficacy between the two methods. Materials and methods: 40 patients received urological surgery under lithotomy position. These patients were randomized into two groups. A group use intermittent pneumatic compression system; B group use elastic cells) was detected. We evaluated the effects of AP on apoptosis-related experiments inducing in TSGH-8301 cells by (i) 3-(4,5-dimethylthiazol-zyl)-2,5-diphenylterazolium bromide (MTT) for cytotoxicity; (ii) cell-cycle analysis and (iii) Western blot analysis of the G2/M-phase and apoptosis regulatory proteins.

Results
: AP potently causes cell death in a dose-dependent manner, and it makes cell cycle arrest at G2/M phase as treating with low doses of AP. In the expressions of proteins, the results showed AP decreases the protein levels of cyclin B1 and cdc2 to cause cell cycle arrest. AP caused apoptosis might be due to increase the apoptosis induce factor (AIF) and the ratio of Bax/Bcl-2 expression. In in vivo assay, the result showed that AP markedly reduces tumor size in TSGH-8301 cells-xenografted tumor tissues.
Conclusion: AP possesses the potential in antitumor ability via mediating the cell cycle arrest and causes apoptosis in human bladder transitional cell carcinoma.

PP30-52
Proposal to increase the learning efficacy of new nursing staffs Shu-E Teng 1 , Chia-Fen Lin 1 , Yi-Han Lin 1 1 Nursing Department, Cathay General Hospital (Taiwan) Purpose: The investigate and identify the problems new nursing staffs may encounter to during their first year in clinical care. Special emphasis has been placed on the degree of emotional impact on the new staffs and various kinds of aid that may be provided by the hospital authorities. At the end of the study, we would draw the conclusion to improve the quality of patient care and safety. In addition, we also proposed solutions to lower the high resignation rate of first-year nursing staffs.

Materials and methods:
Six first-year new nursing staffs from an urological ward of a medical center located in northern Taiwan participated in this study. The structured questionnaires focus on the efficacy of the current training program provided by the hospital and self-assessment on their clinical skills. All of the questionnaires returned.(n=6). The results were processed and analyzed according to decision matrix method. Based on the results, new clinical care guidelines and teaching strategies were established and recorded as video files which could be easily accessed via the hospital on-line intranet learning program, "e-learning".
Results: On the issue of difficulties encountered in learning, 83.3% of new nurses noted that the current teaching method was insufficient to meet the practical demands. Fifty percent of new nurses encountered difficulties even after they have consulted senior staffs. Sixty-six point six percent of new nurses still faced problems in the memorization of daily nursing protocols, even when they have performed them before. Thirty-three point three percent of new nurses were timid in seeking help from senior members. Eightythree point three percent of new nurses were frustrated by the inconsistencies between instructions of the different senior teaching staffs. Most distress came from career disappointment, followed by the attitude and inconsistency between different instructing staffs. After the execution of the"e-learning"program, 100% of senior staffs (n=5) expressed increased willingness to guide new nurses. Eighty percent of senior staffs appreciated the consistency of the teaching material. All new nurses (n=6) were satisfied with the consistency of the teaching programs and the fact that specific relevant materials can be repeated as frequently as needed. All new nurses expressed the willingness to remain in position after the execution of the"e-learning"program.

Conclusion:
On-line e-learning program is an easy way to provide up-to-date training. It can significantly lower the cost of training in comparison with the traditional lecture-based method. Due to its accessibility and ease of modification, on-line teaching program is widely utilized in higher education institutes. We can use it to provide the most up-to-date training for new clinical nursing staffs in order to improve patient safety, clinical care quality, and also job satisfaction.

PP30-53
The management of a complicated urinary peristomal ulcer using Versiva ®XC™ gelling foam dressing Kai Li Lee 1 1 Department of Surgery, Chi Mei Medical Center (Taiwan) Purpose: It is well known that the patients with urinary bladder transitional cell carcinoma post TUR-BT often sustain a poor life quality because of the permanent urostomy. The peristomal skin complication of deep ulcer may disturb the adhesion of urostomy bag on the skin that may further ruin the patient s life quality. The key role to manage this difficult complication is to apply the urostomy bag adequately and to cure the peristomal ulcer as soon as possible that may help the patient enjoy the normal life.

Materials and methods:
A 58-year-old female received an operation of radical cystectomy, urethraectomy, and ileoconduit for the urinary bladder transitional cell carcinoma. Two years later, she started to suffer from urinary leakage followed by a 2 to 3 degree deep ulcer of 3×6 cm 2 surrounding the ileoconduit urostomy region for more than eight months. The initial discomfort, pain, and urine leakage-induced irritant dermatitis with frequent change of urostomy bag three to four times daily ruined the patient s life that was further exacerbated by the multiple past history including (1) Raynaud s phenomenom, (2) Takayasu disease, (3) Myothenia gravis, (4) HCVD induced PAOD and CAD.

A365
We managed the wound with hydrofiber Ag that was covered with non-adhesive Versiva ®XC™gelling foam dressing to absorb the massive discharge. The non-adhesive Versiva ®XC™gelling foam dressing was fixed by transparent film dressing on the top of which the urostomy bag was applied tightly.
Results: With above wound management by tight sealing and isolating the ulcer from urostomy bag, the frequency of changing urostomy bag decreased from three to four times per day to once every two to three days. The peristomal wound began to improve and was completely healed in two months. Therefore, the urostomy bag can be kept for more than five days.

Conclusion:
In the present case, the skin was vulnerable to the hydrocolloide dressing due to the compromised skin condition after a long term administration of corticosteroid implicated with the cardiovascular and immunity disorders. This is the first time we used Versiva ®XC™gelling foam dressing to apply in peristomal skin ulcer. By doing so, urostomy bag can be isolated from the peristomal skin ulcer that obtain a satisfactory environment for wound healing with the benefit of Versiva ®XC™ gelling foam dressing. In summary, it is a challenge to manage a urinary peristomal deep ulcer. From taking care this patient, as a professional ET nurse we learn how to select different dressing to resolve the periostomal complication.

PP30-54
Nursing experience for ketamine-associated ulcerative cystitis The principal presentations are frequency, urgency, urinary incontinence, persistent voiding pain, painful gross hematuria and severe suprapubic pain. Although the associated nursing experience and studies are relative rare, it is necessary to do more research. We would like to share the experience of caring these cases of ketamine-associated ulcerative cystitis to make a quality care.

Materials and methods:
Since 2007 January to 2010 March, 10 cases with recreational ketamine abuse were collected at Kaohsiung Municipal Hsiao-Kang Hospital. The charts were reviewed retrospectively. All the patients underwent imaging study, urine routine, urine culture and treatment.
Results: Our cases with ketamine abuse for 2~6 years have the clinical presentation of persistent painful hematuria, dysuria and suprapubic pain. Imaging finding showed thickening wall of urinary bladder, shrinkage volume of urinary bladder and bilateral hydronephrosis. Those symptoms and bilateral hydronephrosis improved after cease of ketamine use and intravesical instillation of heparin. The thickening wall of urinary bladder seems to be an irreversible reaction. The volume of urinary bladder increase but the maximum volume of urinary bladder is much less than normal.

Conclusion:
Our study shows that it is difficult for initial diagnosis of ketamine-associated ulcerative cystitis because those patients are reluctant to talk to the doctor about ketamine abuse. Afterwards those patients do not get adequate treatment and the condition of disease can not easily be controlled. Including medical treatment, good doctor-patient relationship needs to be established. The most effective way is to stop using ketamine. On the other hand, Kegel exercise and urinary bladder training will be helpful to increase the volume of urinary bladder and improve urinary incontinence. Integrated medical treatment should be connected with psychiatrists, psychotherapist and social workers to improve the quality of care.

A367
Improve the compliance of home care clean intermittent self-catheterization.
Materials and methods: Innovatively design the handouts of self-catheterization and the procedure of catheterizing to plentitude patients'knowledge. Hold the professional training programs for a long term to reduce the occurrence of infections due to self-catheterization. Provide patients a bio-psycho-social care through a complete equipments assemblage model and a correct segregation and minimizing of infectious waste model, for raising the completeness of management of waste and the infectious problem due to improper disposing and decreasing the expense of buying wrong equipments, and the small activities held for patients by the medical team directed by urology.
Results: Each rate of accuracy of each part becomes better during the executing period. The rate of complete assemblage rises from 30% to 90%. The rate of sanitation clean rises from 55% to 80%. The rate of correct posture rises from 30% to 80%. The rate of waste segregation and recycling also rises from 10% to 70%.
Conclusion: Pioneered in designing the procedure of self-catheterization and the medicine injection. It not only makes patient's life quality better but also reduces the occurrence of infection caused by inaccurate selfcatheterization. A complete equipments assemblage model and a correct segregation and minimizing of infectious waste model make each equipment clear to tell, decrease the waste of resource, enrich patients' conceptions of the management of the waste, and increase the protection for patients security and the environmental sanitation.
Results: And then we found that the case had three nursing problems which are health maintenance, altered/knowledge deficit about testicular torsion, pain/acute, and body image disturbance/ orchiedectomy unilateral. It was found that the boy didn't know how to do because of lacking experience of being illness and receiving surgery. And owing to that the surgical site locate on genital organ, he also felt embarrassed under his friends' concern. We thus applied nursing methods such as acitve concern, listening, accompany, talk, and encouragement of expression himself. And we provided information of this disease to improve self-identification of this case.
Conclusion: Due to the above methods, he thus finally accepts the change of body image and restore social character and function with health psychological adjustment. Purpose: The aim of the study is to examine the effects of bladder retraining on symptoms and quality of life among women with overactive bladder (OAB).

Materials and methods:
An experimental design was applied to conduct the research. The subjects recruit who were diagnosed as OAB. In this controlled trial, a total of 78 women were selected from a medical center hospital OPD during October 2007 and September 2008. Subjects were purposely assigned to experimental group or control group by chart number, and a bladder retraining program including pelvic floor muscle exercise training, delayed voiding, time voiding and urge strategy was used as an intervention for experimental group. They visited the urinary incontinence clinic biweekly, and were treated with the bladder retraining program for 2 months, while the subjects in the control group were asked to keep bladder diary without bladder retraining program. The outcome measures included self-grading WHO Quality of life score and Incontinence Impact Questionnaire (IIQ) scales for measuring changes of quantity of incontinence impact and quality of life. The outcome measures will be administrated twice; prior to and after the study intervention. SPSS for Windows will be used to analyze the data. A p-value of < .05 was defined as being statistically significant.

Results:
The results showed that: (1) compared with pretreatment data, there is a significant decrease in the times of urination in daytime (frequency) and night (nocturia) for both the experimental group or control group, but either urgency or urge incontinence was not improved. (2) In experimental group, four factors (physical, psychological, social, and environmental) of WHO quality of life questionnaire were improved significantly. In control group, the environmental factor was the only domain which showed significantly improved. (3) After eight weeks of bladder retraining, the degree of incontinence was decreased. The improvement on all four subscale (travel, social, activity and emotional) was statistical significance.

Conclusion:
The results indicated that bladder retraining helped OAB women enhance their quality of life, and could be one of useful nursing competencies. It is recommended that nurse practitioners can use bladder retraining for patients who are in need.

PP30-60
Non-surgical treatment for urodynamic stress incontinence after failed pelvic floor muscles exercise Purpose: Introduction: Stress urinary incontinence is involuntary loss of urine on effort or physical exertion including sporting activities etc, or on sneezing or coughing. Pelvic floor muscles exercises are one of the first-line treatments for stress urinary incontinence. If the patients prefer an option other than surgery but are unable to effectively perform Pelvic floor muscles exercises, the urologists will refer the patients to our Urology Nurse Clinic for Urodynamic study and Pelvic Floor Muscles Rehabilitation.
Objectives: A retrospective review to evaluate the Pelvic Health Program in the management of Urodynamic Stress Incontinence.

Materials and methods: From November 2003 to
December 2009, a total of 39 female patients who have tried Pelvic Floor Muscles Exercise (ranged from 0.5-6 years) with unsatisfactory results were referred to our Urology Nurse Clinic for Pelvic Floor Muscles Rehabilitation. Urodynamic studies were done and Urodynamic Stress incontinence was confirmed for these patients. Patient's age range from 32-79 (mean 56) years old were treated with 6-12 weeks Pelvic Health Program. The Pelvic Health Program is a combined therapy with Transvaginal or Transanal Electrical Stimulation, sEMG Biofeedback and Pelvic Floor Muscles Exercise re-education. They were followed up for 6 -43 (mean 16) months.
Results: Five women dropped out from the pelvic health program at initial treatment period because they felt time consuming. 34 patients completed a course 6-12 weeks treatment. Three patients requested second course of treatment after 1 year and found their urinary leakage had improved. Total five patients requested continence surgery even with some improvement after the pelvic health program. 30 out 34 and were satisfied with their continence with improvement in QoL score. 25 out of 34 patients had significant improvement in sEMG activity on squeezing.
Conclusion: Stress urinary incontinence is common and is a highly unpleasant symptom for both nurses and patients, and can be very distressing. Many patients have difficulty in identifying and isolating the pelvic floor muscle and are unable to perform the exercises effectively. Pelvic health program appears useful in managing the urodynamic stress incontinence. Pelvic Health Program is an effective option for treating urodynamic stress incontinence if symptoms not improved by pelvic floor muscles exercise.

PP30-61
To reduce urethral pain from the post-operative use of the indwelling urethral catheter with interventions Shun-Hsuan Yang 1 1 Department of Nursing, National Taiwan University Hospital (Taiwan) Purpose: To investigate the overall effects of several interventions on reducing urethral pain from the indwelling urethral catheter after surgery.

Materials and methods:
The placement of an indwelling urethral catheter after urological surgery is usually inevitable and urethral pain associated with the presence of the catheter may be quite significant in some patients. In our department, a pain index is specifically developed to evaluate the pain from the use of the indwelling urethral catheter. 30 patients with the indwelling urethral catheter received interventions aimed at reducing urethral pain and 30 patients did not receive the intervention. The interventions included patient education, catheter fixation, pain medication, manual irrigation of the catheter when needed and so on.

Results:
The maximal score of the pain index is 10. The average score of the patients without interventions was 5.4 2.3 which was significantly higher than the average score (3.2 1.4) of the patients receiving interventions.

Methods:
A cross-sectional design was used to gather data from 49 nurses and 125 NH residents. Participants completed a questionnaire consisting of 3 parts: (1) the Knowledge of UI (2) the demographic data and (3) Attitudes toward Continence Promotion. In addition, clinical care checklist was used to check management strategies of UI.
Results: Nurses answer 87% of the questions correctly, while nursing assistants only obtained 23.7% correct responses of UI knowledge subscale (p<0.05). The level of knowledge of the nurse assistants is lower than that of nurses despite nurse assistants provided major continence care in NH. In related to UI management strategies, 70 residents (61.4%) received 24 hours diaper used. Only 5 residents use toilets and none of the residents have tried PV or schedule toileting program. Nurse assistants related "reasons of diaper use"to"contain odor","prevent leak"and "time saving"management strategies. Only one-third of nurse heard about prompt voiding (PV) and none of nurse assistant heard about PV before. Education and experience in the field are associated with the level of knowledge.

Conclusions:
Results demonstrate that knowledge and attitude are related to management strategies and significant difference of knowledge difference between nurses and nursing assistants was revealed. The management strategies can best influenced by knowledge and behavioral attitude. Proper education program for nursing assistants is urgent to enhance incontinence care in nursing home and long term care facilities.

A373
risk, sleep disturbance and low situational self-esteem. During the nursing period, the author tried to establish trusted nursing-patient relationship in several aspects, such as the bladder training and pelvic floor exercise to improve the severity of urine incontinence, the nursing procedures in urinary tract infection prevention and skin care to prevent the potential infection risk and the application of daily diary and time table of daily life to improve sleep quality. The author also used several approaches in helping this patient to restore the life quality for aging male, such as listening and offering disease information to comfort the patient about the change of body image after operation, instructing the patient about the self-care skills about urine incontinence to prevent the discomfort and embarrassing condition due to urine incontinence, to share personal experience with other patients and to join community activities to improve the health problems associated with low situational self-esteem.

Conclusion:
The author tried to share the experience with nursing staffs at outpatient department about the successful management in a patient with urinary incontinence at the outpatient department, which might serve as nursing care option for patient with urinary incontinence at the outpatient department. Purpose: Pressure ulcer is a very important issue in clinical setting. The purposes of this study were (1) to explore the prevalence rate of pressure ulcer (2) to detect the risk factors of pressure ulcer.

Materials and methods:
The research design was crosssectional survey, instruments were include demographic tool, Braden Risk Factor Scale, and pressure ulcer record tool. There were 1198 patients complete the data collection.
Results: Result finding were (1) prevalence rate of pressure ulcer was 3.9% (excluding stage 1), (2) the majority of pressure ulcer patients were old men, stage II pressure ulcer, in sacrum and hip area, and almost nosocomial pressure ulcers, (3) 22.4% of inpatients were high risk group.

Conclusion:
Following the results, we will evaluate the protocol of pressure ulcer prevention and improve the quality of nursing care. The elderly patients had poor nutrition, and immobility were the risk factors of pressure ulcer.

PP30-69
The concept of wound bed preparation in chronic wound care Jui-Ping Lin 1 , Yen-Jou Lee 1 , Pei-Hsi Li 1 1 Taipei Veterans General Hospital (Taiwan) Chronic wound causes huge medical resource burden and is one of the most important topic in wound nursing. In the case report, the traumatic wound, at medial aspect of left lower tibia, had not healed for 4 years. By the wound bed preparation concept, we adopted comprehensive wound evaluation, discover the factors involving poor wound healing and apply continuous mechanical, autolytic and surgical debridement. Besides, we use dressing to control proper moisture balance, reducing microorganism load and improving microbiology environment in the wound. The wound healed in two months.
Purpose: Change of wound pattern has become more and more complicated and diversified due to the extension of human life and increase of chronic diseases. Chronic wound has caused huge medical resource burden and is one of the most important topic in wound nursing. The wound bed of chronic wound often stays in proliferative phase and becomes unhealed. By the wound bed preparation concept, we can systematically confirm and resolve the potential problems of unhealed wound. It includes systematic wound evaluation, physical evaluation, medicine treatment, mental status and social adaptation. There are 4 procedures for wound bed preparation .They are administered in order of "TIME". T ( Tissue ) for evaluation of any necrosis or tissue without activity.I ( Infection or Inflammation ) for evaluation of infection or inflammatory status. M ( Moisture Imbalance ) for evaluation of wound moisture environment. E (Edge of Wound) for evaluating the wound s edge and potential or undermining wound. Based on pathological changes of" TIME", the goals for wound bed preparation are decreasing the microorganism load, proceeding continuous debridement, controlling proper moisture balance, improving microbiology environment in the wound, and accelerating healing by bringing the wound into proliferate phase.

Materials and methods:
Wound evaluation: Systematic assessment, Wound assessment TIME Wound treatment (1) Microorganism load in the wound bed (2) Continuous debridement (3) Control of proper moisturizing environment (4) Nursing instructions: Self-Care at home Results: The patient s wound was healed entirely in two months.
Conclusion: By the wound bed preparation concept and adoption of related treatment goals, we can systematically confirm and resolve the potential problems of unhealed wound. Besides, related dressings were applied well in this particular treatment. Finally, the patient s wound undermined for 4 years, healed in two months.

Conclusion:
Use of non-ionic iodinated contrast medium had low incidence rate of adverse reaction around 0.344%-0.417%. In addition to that, there was no fatal or severe adverse reaction with non-ionic iodinated contrast medium in IVP and CT scan. In conclusion, the non-ionic iodinated contrast medium was a relative safety contrast medium and can be used widely in Taiwanese.