Ki Kyung Kim

Developmental Regulation of Collagen Differential Expression in the Rabbit Bladder

PURPOSE It has been suggested that the amount and relative ratios of different types of collagen influence bladder compliance. To understand the mechanisms regulating collagen synthesis and degradation in the bladder we investigated the gene expression of collagen types I and III in the rabbit bladder during normal development. MATERIALS AND METHODS New Zealand white rabbits ages fetus to adult were used for this study. The mid portion of the bladder wall was harvested. Northern blot hybridization was performed to analyze quantitatively collagen types I and III messenger (m) ribonucleic acid (RNA), and in situ hybridization was done to localize the messages. Corresponding protein distributions were obtained by immunohistochemical staining. RESULTS Types I and III collagen are developmentally regulated at the level of gene expression. The temporal and spatial distribution of the mRNA transcripts of alpha 1(I) and alpha 1(III) correlates with extracellular protein deposition. Differential distribution of the mRNA transcripts is also developmentally regulated. CONCLUSIONS This study characterizes the relationship between collagen gene expression and normal rabbit bladder development. The expression of alpha 1(I) and alpha 1(III) alters as the bladder grows. High levels and nonconcordant up and down regulation of different types of collagen mRNA during early development demonstrate the complexity of the extracellular matrix in a young bladder. This observation may be important in our understanding of the injury response in a developing versus mature bladder.

An Alternative Panel Flutter Approach Utilizing Minimum Angle Tracking

An alternative panel flutter approach utilizing minimum angle is presented. This method utilizes eigenvectors rather than eigenvalues. The minimum angle is the lowest value among the angles between modes i and j at a certain pressure condition. Cross-ply composite plates are considered in this study. A remarkable result of this investigation is that the angle always dropped gradually to zero for all presented examples without regard to the flow angle and the stiffness ratio, E1/E2. Present study shows that the minimum angle tracking scheme can be used to analyze panel flutter.

MP27-07 CAN WE PREDICT THE LEARNING CURVE FOR HOLMIUM LASER ENUCLEATION OF THE PROSTATE (HOLEP) BY USING SIMULTANEOUS PARAMETER OF ENUCLEATION-MORCELLATION?

INTRODUCTION AND OBJECTIVES: Holmium laser enucleation of the prostate (HoLEP) is a minimally invasive laser therapy for benign prostatic hyperplasia. However, a steep operative learning curve may be the main drawback to use of HoLEP. The enucleation ratio or efficacy were known as one of the parameters for estimating the learning curve. But this parameter is only focused on time of enucleation not considering morcellation, even though operators spend time of enucleation and morcellation simultaneously during HoLEP surgery. The aim of this study was to evaluate a various method to assess the learning curve of HoLEP of a single surgeon. METHODS: Ninety-two consecutive cases performed by the single surgeon were enrolled. Intraoperative measures, including enucleation time, enucleation ratio (enucleated weight/transitional zone volume), enucleation efficacy (enucleated weight / enucleation time), consumed energy, morcellation time, morcellation efficacy (enucleated weight / morcellation time) and enucleationmorcellation efficacy (enucleated weight/enucleation and morcellation time) were analyzed. Perioperative morbidity, length of hospital stay and length of urinary drainage were also investigated. In addition, functional outcomes such as Qmax, post-void residual volume, IPSS and QoL scores at 3 and 6months were also investigated. RESULTS: The mean age of the patients was 72.9 years (49-86) with a mean prostate volume of 59.2 cc (34-180) on transrectal ultrasonography. Within all procedures, mean total operative time was 86.5 minutes (45-260 minutes) with a mean enucleated weight of 42.2 g (25-120 g). Mean enucleation time, consumed energy, morcellation time and enucleation ratio were 48.9 12.1 min, 67.5 22.8 kJ, 22.4 14.5 min and 0.64 0.32 g/mL, respectively. In terms of efficiency, enucleation efficacy, morcellation efficacy and enucleation-morcellation efficacy were 0.42 0.37 g/min, 4.24 1.26 g/min and 0.24 0.11 g/min, respectively. Perioperative complications were observed in 12 of 92 (13.0%). Of these, 10 were urinary tract infection and 2 was urethral stricture. Considering the learning curve, the plateau of enucleation efficacy was reached after 38 cases. However, considering enucleation and morcellation time simultaneously, enucleationmorcellation efficacy has an increasing trend even after 38 cases and has remained roughly constant after 55 cases. Based on these criteria, we divided cases into two groups. Enucleation efficiency was significantly higher after 38 cases. Morcellation efficiency was also higher in the second group, however, the difference was not significant. Enucleation-morcellation efficiency was significantly higher after 55 cases. Perioperative morbidities, hospital length of stay, urinary drainage length and functional outcomes at 3 and 6months were not significantly different between the groups based on these criteria. CONCLUSIONS: Although the learning curve did not interfere with functional results, our results demonstrated that even after 38 cases, surgical skill advances are still needed. Of these factors, morcellation time is as important as enucleation time in the whole surgical procedure. Enucleation-morcellation efficacy might be considered a better parameter for estimating the operative learning curve of HoLEP rather than enucleation efficacy alone.

Functional Assessment of the Hautmann Ileal Neobladder with Chimney Modification Using Uroflowmetry and a Questionnaire

Urinary diversion reconstruction is essential after radical cystectomy and neobladder reconstruction is accepted as a fine option. This study included 51 patients, who underwent radical cystectomy with orthotopic neobladder reconstruction by a Hautmann ileal neobladder with chimney modification from 2006 to 2014. Functional outcomes were evaluated using a questionnaire and uroflowmetry. Perioperative complications were analyzed retrospectively. The mean follow-up period was 36.1 months. Eighty-six percent of patients voided without clean intermittent catheterization (CIC) assistance. CIC was used 1-2x per day or every time they voided in 8% and 6% of patients, respectively, and 71% of patients were continent. The percentages of patients who used 1, 2, 3-4, and ≥5 pads per day were 15%, 6%, 2%, and 6%, respectively. Daytime and nighttime continence were achieved in 86% and 69% of patients, respectively. Daily mucus leakage was reported in 69% of patients. The mean maximum neobladder capacity, voided volume, postvoid residual volume, and maximum flow rate were 413.2 mL, 370.6 mL, 43.7 mL, and 20.8 mL/s, respectively. Eighteen early and 5 late complications developed in 13 and 5 patients, respectively. Reoperations were needed in 7 patients. The Hautmann ileal neobladder with chimney modification provided satisfactory results regarding functional outcomes.

MP80-18 CORRELATION BETWEEN OVERACTIVE BLADDER SYMPTOM SCORE (OABSS) AND NEUROPSYCHOLOGICAL PARAMETERS IN ALZHEIMER'S DISEASE PATIENTS WITH LOWER URINARY TRACT SYMPTOM

RESULTS: Of the 128 patients who underwent SPC, 105 patients (64 female, 41 male) fit the inclusion criteria and were sent the PGI-I questionnaire. Response rate was 44.8% (47/105). Mean age at the time of SPC placement was 54.9 years. Mean follow up was 25.1 months (1-120). Overall, 53 pts had MS, 26 had SCI, 4 had PD, 22 had other neurologic disorders (cerebrovascular accident, cerebral palsy, brain tumor, seizure disorder, transverse myelitis). Overall, success was seen in 41/47 patients (87.2%). Only 6.4% (3/47) patients reported a negative PGI-I (score 5-7/7). An early postoperative complication (within 30 days of surgery) was seen in 1/ 128 patients (0.08%) and consisted of bowel perforation requiring small bowel resection. CONCLUSIONS: SPC is an effective solution in many carefully selected patients with NGB conditions. Over 85% considered the SPC to have improved their urological quality of life with a mean follow-up of over 2 years. Adverse events are rare, though can be particularly serious in this group of neurologically impaired patients.