SELECTED ABSTRACTS

Monday, October 4, 2004
MP-1: Infections and Inflamatory Diseases

MP-1.01

Can the free-to-total PSA ratio differentiate between prostatitis and prostate cancer?

Delaere K., Baumgarten B.
Atrium Hospital Heerlen, Deparrtment of Urology, Heerlen, The Netherlands

Introduction & Objectives: In clinical practice it might be difficult to differentiate between prostatitis and prostate cancer. In case of prostate cancer, the ratio of free-to-total PSA is usually lower than 18%. The question arises whether in case of prostatitis, the free-to-total PSA ratio remains normal or higher than 18%. In the literature there are indications that the free-to-total ratio of PSA is of no value to discriminate between cancer and inflammation. In a retrospective study, we have evaluated the changes of total PSA and the free/total ratio of PSA, during and after cure of acute prostatitis.

Material & Methods: During 4 years, 91 consecutive patients (mean age 62 years) have been followed clinically as well as biochemically (total PSA, F/T PSA ratio). The diagnosis prostatitis was based on clinical grounds, such as positive urine culture, improvement under antimicrobial therapy and decrease of total PSA. Prostate biopsies were taken if they rised any suspicion of cancer. For statistical analysis, a pared Student t-test has been used.

Results: At clinical presentation, the patients with prostatitis had a mean total PSA (± SEM) of 20.3 ± 9.5 µg/l and a mean F/T PSA ratio of 15.5 ± 0.8 %. After treatment these values changed to 4.3 ± 0.4 µg/l and 22.1 ± 0.9%. The statistical difference between the mean F/T ratio of PSA, during the acute phase and after treatment, was significant (p<0,001).

Conclusions: By means of this retrospective analysis it has been confirmed that the free-to-total PSA ratio in case of acute prostatitis is lower than 18%. After treatment of the inflammation, the F/T ratio declines to normal values. In conclusion, the F/T ratio of PSA don't contribute to differentiate between cancer and prostatitis.

MP-1.02

Terazosin in patients with chronic prostatitis

Sivkov A., Oshepkov V., Egorov A., Pataki K.
Institute of Urology, Innovation, Moscow, Russia

Introduction & Objectives: Nowadays prescription of alpha-1 blockers (α1-AB) for treatment of LUTS due to BPH is a common practice. There are several publications dedicated to successful use of α1-AB in chronic prostatitis (CP) but randomized placebo-controlled trails are still rare.

Material & Methods: We studied efficacy of terazosin in patients with chronic abacterial prostatitis (CP-III NIH) in randomized double blind pilot study. 51 patients aged 20-40 years were randomized in two groups. Group A (n=22) received placebo for 60 days, group B (n=29) - terazosin 5 mg daily. Symptoms were evaluated using frequency and severity scales, NIH-CPSI score. Amount of WBC in prostatic secretion was measured.

Results: We found marked (t-test) improvement of symptoms frequency in both groups: A (p = 6.78 * 10^-7) and B (p = 8.96 * 10^-13) with statistical advantage in group B (p = 0.0009). There were no statistically significant changes in symptom severity scale. NIH-CPSI scale showed significant reduction of symptoms 1-4 in both groups: A (p = 3.27 * 10^-7) and B (p = 2.05 * 10^-15) with significant difference between groups (p = 0.001). Dysuria (questions 5-6) was evaluated with marked improvement in group B (p = 4.66 * 10^-8) whereas no improvement was reported in group A. Improvement of QOL (questions 7-9) was reported in group B (p = 0.00001). Also in active treatment group we found statistically significant reduction of WBC in prostatic secretion (Mann-Whitney-test, p = 0.0478). Median survival of treatment efficacy reached 25 weeks in terazosin group vs. 9 weeks in placebo group with statistically justified difference (Gehahn-test, p = 0,035).

Conclusions: α1-AB (terazosin) is an effective treatment modalities option for patients with chronic abacterial prostatitis (CP-III) vs. placebo.

MP-1.03

Prevalence, characterization, diagnosis and treatment of the prostatitis patient in Italy: an opportunity to compare the European prostatitis patient to the North American experience

Nickel J.¹, Rizzo M.², Marchetti F.³, Travaglini F.^2
1Queen's University, Urology, Kingston, Canada, ²University of Florence, Urology, Florence, Italy, ³GlaxoSmithKline, Urology, Verona, Italy

Introduction & Objectives: A prospective multicenter urology outpatient survey undertaken to examine prostatitis in Italy, provided an ideal opportunity to compare the prevalence, characterization, diagnosis and treatment of the typical European prostatitis patient to the North American (NA) prostatitis patient.

Material & Methods: Seventy Italian urologists counted and recorded the overall total male patients reported in the clinic and the overall total patients diagnosed with prostatitis over a 5 week period. Data regarding demographics, previous diagnoses, symptoms (frequency and severity), quality of life, physical examination, laboratory data and therapy instituted was prospectively collected. Results were compared with published practice prevalence and cohort data (in particular the NIH and Seattle Prostatitis cohorts) examining similar data in NA.

Results: 1,148 patients were identified with prostatitis (12.8%). 1,074 patients had complete data to be included for this characterization analysis. Mean age of the prostatitis patients was 47.1 (range 16-83); two thirds had experienced their first symptom within the last year. The most common urinary diseases were BPH (17.4%), recurrent UTI (11.2%) and urinary calculogenesis (11.1%) while the most common concurrent diseases were diabetes (7.2%) and depression (6.8%). The most frequently reported and most severe symptoms were irritative voiding symptoms, perineal and suprapubic pain/discomfort. Three quarters of the patients were dissatisfied with their quality of life. Bacteria were cultured in 15.6%, 17.7% and 14.0% of EPS, VB3 and semen specimens respectively. While 98% of the patients underwent a digital rectal examination, less than 3% of the patients underwent the Meares-Stamey 4-glass test. The most common treatment prescribed was non-antibiotic drug therapy. Comparison to NA data suggests that the diagnosis and treatment of prostatitis in Europe is not that dissimilar to prevalence and management of prostatitis in NA.

Conclusions: Prostatitis is a common worldwide outpatient diagnosis, comprising a significant percentage of male outpatient visits to urologists in both Europe and NA. The similarities in prevalence, characterization and management of the typical prostatitis patient suggests that an international collaborative research effort is indicated in this important urological condition.

MP-1.04

The three A's of prostatitis therapy: Canadian evidence for antibiotics, alpha blockers and anti-inflammatories

Nickel J.
Queen's University, Urology, Kingston, Canada

Introduction & Objectives: Antibiotics, alpha-blockers and anti-inflammatories are the three most common medications prescribed by urologists for the treatment of chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS). Until recently there has been no conclusive evidence to judge their efficacy in ameliorating CP/CPPS symptoms in clinical practice. The general acceptance of a definition and classification system for chronic prostatitis and development of a validated outcome symptom index, the National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI), has stimulated a flurry of clinical research to evaluate the most common treatments used in CP/CPPS. Five prospective randomized placebo controlled trials designed, at least partially implemented and analysed in Canada have led the world in expanding our understanding of the role of antibiotics, alpha-blockers and antibiotics in CP/CPPS.

Material & Methods: One antibiotic trial, two alpha-blocker trials and two anti-inflammatory trials randomized 435 patients to active drug or placebo (levofloxacin n= 80; alfuzosin n=37; tamsulosin n=57; rofecoxib n=161; pentosanpolysulfate n=100). * p< 0.05

Results:

Conclusions: The efficacy of the three most common treatments for CP/CPPS is modest at best. Consideration for future clinical trials should include novel therapies and/or combination therapies.

MP-1.05

Effects of dutasteride on inflammatory chronic bacterial prostatitis. the impact on patients? quality of life

Lianos E., Mountrakis S., Zampiozis E.
General Hospital Agios Nikolaos, Urology, Agios Nikolaos, Greece

Introduction & Objectives: Aim of this study was to evaluate whether the adjunction of dutasteride in a combination therapy of oral fluoroquinolones and lornoxicam (cox-2 non steroid anti-inflammatory drug), has any influence on relieving symptoms and on improving quality of life in patients with chronic pelvic pain syndrome (chronic prostatitis).

Material & Methods: We investigated thirty patients with chronic bacterial prostatitis (NIH category IIIa), diagnosed by the localization of leucocytes in the expressed prostate secretions (EPS), in the urine obtained after prostate massage (voided bladder urine-3 - VB3) or in semen material. Patients in trial were managed with oral fluoroquinolones (levofloxacin 500mg) and lornoxicam 8mg , a cox-2 non steroid anti-inflammatory drug , once a day. Fifteen patients received additionally to this therapeutic protocol, Dutasteride (5 á-reductase inhibitor) 0.5 mg daily. All patients were treated for an eight to twenty weeks period. Efficacy ware evaluated by analysis of symptomatic improvement throughout responses to quality of life questionnaires, International Prostate Symptoms Score (IPSS), Prostatitis Symptom Severity Index (PSSI), pain evaluation on VAS (visual analogical scale), analgesic use, residual volume, prostate volume and variations of serum PSA.

Results: Prostatitis Symptom Severity Index dropped significantly in patients in the plus dutasteride group. Recurrences rate was lower in plus dutasteride patients group. There were small differences in the changes of prostate volume and on residual urine volume. Serum prostate-specific antigen concentrations dropped dramatically in patients under treatment with dutasteride. Most patients (7/10) refer quality of life was better when dutasteride were added in their therapy. The groups did not differ with regard to side effects except three patients in the dutasteride group (20%), accusing decrease of their libido.

Conclusions: Our results indicate that dutasteride has an beneficial effect in patients with chronic pelvic pain syndrome, chronic bacterial prostatitis. The mechanisms by which dutasteride works in these patients are unclear and could not be solved in this preliminary study, which had relatively few patients. A further trial with larger numbers is required to confirm these results.

MP-1.06

Isolation and identification of bacteria causing catheter-associated urinary tract infection (ca-uti) from biofilm in Foley catheter and analysis of autoinducer gene expression related quorum sensing mechanism

Lee J.Y.¹, Koh J.S.², Hwang J.H.³, Peck K.R.⁴, Jung H.T.⁵, Song S.Y.⁶, Ghil S.H.⁶, Lee S.S.^6
1The Catholic University of Korea, Holy Family Hospital, Urology, Pucheon-si, South Korea, ²The Catholic University of Korea, Dept. of Urology, Pucheon-si, South Korea, ³School Of Medicine, Sungkyunkwan University, Dept. of Physical Medicine & Rehabilitation, Seoul, South Korea, ⁴School of Medicine, Sungkyunkwan University, Dept. of Internal Medicine, Seoul, South Korea, ⁵Korea Advanced Institute of Science and Technology, Dept. of Chemical Engineering, Daejeon, South Korea, ⁶Kyonggi University, Dept. of Biological Engineering, Suwon, South Korea

Introduction & Objectives: Catheter-associated urinary tract infection (CA-UTI), which is frequently occurring in the patients with indwelling Foley catheter, can cause serious morbidity or mortality. But there was no report about quorum sensing mechanisms in indwelling Foley catheter. In this study, we tried to find out the quorum sensing mechanisms of isolated bacteria from biofilm in Foley catheter.

Material & Methods: Silicone Foley catheters were indwelled in the patients with neurogenic bladder. The catheters were removed with insertion time (1, 3, 5, 7, 14 and 28 days). The biofilm formations on catheters were evaluated by routine culture methods and microscopy with insertion time. The rhlI and lasI gene, which were reported to autoinducer (AI) syntheses gene, were carried out cloning in Pseudomonas aeruginosa, and yagG in E.coli, lux S in Staphylococcus saprophyticus. The yagG gene was analyzed a quantity of mRNA expression rate by competitive RT-PCR according to the time.

Results: Through aerobic cultivation 175 strains were isolated and 283 strains were obtained under anaerobic culture conditions. Two to three species of bacteria were isolated from a catheter in each patient. Most common species were Pseudomonas, Klebsiella, Serratia, Proteus, and E. coli. The autoinducer (AI) syntheses gene rhlI & lasI for Pseudomonas aeruginosa, yagG in E.coli, lux S in Staphylococcus saprophyticus were detected by RT-PCR. In competitive RT-PCR of yagG gene, the mRNA expression was 0 copies/ml at 1 day, 0 copies/ml at 3 days, 10⁴ copies/ml at 5 days, 10⁹ copies/ml at 7 days, 10⁹ copies/ml at 14 days and 10⁸ copies/ml at 28 days.

Conclusions: The autoinducer synthetase gene (rhlI, lasI, yagG & lux S) expression associated quorum sensing mechanism was first documented in CA-UTI. In competitive RT-PCR, yagG gene expression was increased according to the time.

MP-1.07

The prevalence of bacterial colonization of ureteral stents

Khosropanah I., Mohammadzadeh R., Roshani A., Askari S.A., Salehi M., Dezhabad V., Falahatkar S., Mokhtari G., Madani A.H.
Guilan University of Medical Sciences - Razi Hospital, Urology, Rasht, Iran

Introduction & Objectives: Application of ureteral stent is one of the urological procedure which results in excessive morbidity. One of the most frequent complications is bacterial colonization of the stent. Aim of this study is to determine the prevalence of bacterial colonization of this device.

Material & Methods: This prospective study was performed on 63 patients with temporary ureteral stent which they received prophylactic antibiotics, between June 2002 and December 2002. For all the patients urinary culture before introduction and then after removal of the stent and culture of the distal end stent was performed to determine the bacterial colonization of the device. All of these cases were under closed observation for the complication and antibiotic coverage.

Results: A total of 63 cases, 27(42.85%) cases were female and 36 (57.15 %) were male. Over 60% were within the age group of 20 -50 years old. Among these cases, 6 patients (9.52%) had renal stone and 51 (80.95%) had ureteral stone and 6 other cases under went stenting for ureteral stricture. The lab tests showed positive urinary culture in 9 (14.28%) patients before stenting and in 16 (25.39%) cases after removal of stent. The culture of stent was positive in 36 (57.9%) patients (15 cases female and 21 cases male). Duration of stenting varied 7-55 days (average 32.6 days).

Conclusions: This study suggests that bacterial colonization of ureteral stent was highly prevalent in spite of antibiotic prophylaxis.

MP-1.09

The management of haemorrhagic cystitis with sodium pentosan polysulphate (Elmiron)

Sandhu S., Symes A., Goldstraw M., Woodhouse C.
Royal Marsden Hospital, Department of Urology, Hampstead, United Kingdom

Introduction & Objectives: Haemorrhagic cystitis can be an unwelcome side effect in patients being treated for malignancy. It is a difficult condition to manage in patients with significant preexisting co morbidity. We have used sodium pentosan polysulphate (SPSS) to treat this difficult condition and present our results.

Material & Methods: 59 consecutive patients (24 female and 35 male), suffering with haemorrhagic cystitis between September 1991 and December 2000 were primarily treated with sodium pentosan polysulphate (SPSS). 52 patients had radical radiotherapy for pelvic malignancy and seven patients received systemic chemotherapy. All patients were screened for blood dyscrasias, and residual/primary urothelial malignancy with imaging, urine cytology, and a cystoscopy.

Results: A total of fifty patients were available for follow up. The mean interval between completion of treatment and the development of haematuria was 8 years and 10 months (range one month to 39 yr and 5 months) the mean duration of treatment was 440 (range 21 -1745) days. All patients were started on SPSS at an initial dose of 100 mg tds and this was gradually reduced to a maintenance dose of 100mg (20 patients), in ten patients SPSS was stopped due to complete and sustained cessation of haematuria. Twenty patients died on treatment due to causes not directly related to their haematuria. No patient required surgical intervention.

Conclusions: We recommend the use of SPPS as the primary modality in the management of haemorrhagic cystitis associated with pelvic radiotherapy or systemic chemotherapy.

MP-1.10

Seminal vesicle abscess induced by mycobacterial tuberculosis

¹Farshi, A., ²Houseini, S.Y.
¹Social Security Organization, Urology, Tehran, Iran, ²Beheshti University, Urology, Tehran, Iran

Introduction & Objectives: We present a case of seminal vesicle abscees that is a rare condition.

Material & Methods: The patient presented with irritative symptoms and physical examination was unremarkable except for apainless mass in supraprostatic location in digital rectal examination. Only abnormal labratory value included leukocytosis.Abdominal and transrectal ultrasound showed enlarged prostate that suspected to abscess. The subsequent IVP was normal. Computed Tomographry (CT) revealed a central multiloculated mass in the back of prostate and cystoscopy showed elevation in proximal urethra and trigone. The patient underwent open drainage via a paravesical approach. Aspiration of mass yieldded thick pus which on culture showed mycobacteria tuberculosis.

Results: Histological examination revealwd inflammation with numerous lymphocytes and larg necrotic areas lined by giant cells. Postoperatively the patient was treated with isoniazid and rifampin. A follow-up CT scan at 12 weeks showed resolution of abscess and rectal examination was normal.

Conclusions: Treatment of seminal vesicle abscess usually consists of surgical or needle drainage. Transperineal or transrectal drainage are attractive but sometimes they may not provide adequate drainage. Surgical drainage is usually necessary due to multiloculated nature of abscess.

MP-1.11

The infected urachal cyst: presentation and management

Soman T.
Tosei Hospital, Dept. of Urology, Seto, Japan

Introduction & Objectives: The urachus is an embryonic structure that persists after birth in some individuals cause and can cause various problems. It has been reported that urachal cysts are rarely detected in adulthood compared with them in childhood. We review and analyze all cases of infected urachal cyst treated at Tosei hospital between 1995 and 2003.

Material & Methods: A retrospective study on 13 patients with infected urachal cyst treated from 1995 to 2003 was reviewed with special attention to age, clinical and radiographic details of presentation, microbiology, surgical management, and complication.

Results: Thirteen patients with infected urachal cyst at a median age of 22 years (range 8 years to 35 years) were identified ;there were eight male and five female. Ten (72%) presented with lower abdominal pain and purulent discharge , 4 (30%) with fever, 3 (23%) with umbilical polyps/granulation. Ultrasound scan and computed tomographic were diagnostic in all cases. Urinalysis and urine cultures did not correlate with infection. We treated 9 cases with a two-stage surgical procedure. The postoperative course was uneventful in all cases. Overall, 4 patients underwent incision and drainage under appropriate antibiotic coverage without complete excision of the urachal cyst.

Conclusions: Infected urachal cyst can present at any age with a variety of clinical manifestations. Ultrasound examination and computed tomographic can be useful for diagnosing urachal cysts. Additional diagnostic studies generally are not warranted. In case of acute infection, a two-stage surgical procedure may be preferable to avoid unnecessary risks.

MP-1.12

The Clinical Significance Of Plasma C-reactive Protein In Patients With Acute Uncomplicated Pyelonephritis

Kim H., Yang S., Kim T., Sung W., Jung H.
Kon-Kuk University, Urology Department, Chung Ju Si, South Korea

Introduction & Objectives: Plasma C-reactive protein is the prototype acute-phase protein. Increased plasma C-reactive protein is occurred within six to twenty-four hours, and the level increases up to 2000 times. In order to find factors which predict a result of the treatment and the change time of using intravenous antibiotics to oral medication, plasma C-reactive protein (CRP), white blood cell (WBC), and body temperature (BT) were compared.

Material & Methods: Between May 2003 and February 2004, 41 female patients with acute uncomplicated pylonephritis were enrolled. Plasma CRP, by particle-enhanced immunonephelometry method, as well as BT and WBC were measured at first, third, fifth and seventh day after admission and followed by seventh days after discharging from a hospital. The duration and pattern of increased CRP, BT and WBC after using intravenous antibiotics were assessed statistically.

Results: The plasma CRP, BT and WBC count of all patients were increased at the first hospital day. After treating with intravenous antibiotics, the duration of elevating CRP, BT and WBC count was tested by Krusckal-Wallis method, as well as the pattern of changes of each variables by Proc mixed method. Only plasma CRP was statistically correlated (P<0.0001). At the first hospital day, the average plasma CRP (reference range: 0mg/dL-1mg/dL) was increased up to 11.3mg/dL(range:1.3mg/dL-33.23mg/dL). After using intravenous antibiotics, the mean plasma CRP was measured as 8.58, 4.0mg/dL2mg/dLand 1.96mg/dLat third, fifth and seventh day after admission, respectively. After the patients discharged from a hospital, there were no cases for either increasing plasma CRP or recurrence of inflammation during follow-up period. Both BT and WBC count were normalized at the third hospital day.

Conclusions: Clinically, the plasma CRP is a better indicator to determine the therapeutic effect in patients with acute uncomplicated pyelonephritis than BT and WBC. Especially, in the patients whose plasma CRP value was decreased below 2mg/dLat early hospital day, the conversion of using intravenous antibiotics to orally would be sooner than the usual period using intravenous antibiotics for acute uncomplicated pyelonephritis.

MP-1.13

Activity of Barrington's nucleus in rats with bladder inflammation

Gajewski J., Liu Y., Downie J.
Dalhousie University, Urology, Halifax, Canada

Introduction & Objectives: Barrington's nucleus (Bar) in the pons has been defined as being critically important to control of micturition in the cat and rats has been confirmed. Although some assumptions have been made about how it functions, there is little direct information on the activity of Bar neurons during the continence/micturition cycle in either normal conditions or in the presence of bladder inflammation. We sought to determine whether the activity of Bar neurons was consistent with Bar being the site of the postulated switch mechanism that changes neural control of the bladder from continence mode to micturition mode. We also wanted to determine whether the relationship between Bar activity and bladder contractions was preserved during the abnormal bladder activity that arises after bladder inflammation.

Material & Methods: Rats were anesthetized with urethane (1.3 g/Kg) and the bladder cannulated through the dome with a silastic tube. After closing the abdominal incision, the rat was placed in a stereotaxic frame and a small craniotomy carried out. A Tungsten wire recording electrode (10-12 MOhm) oriented 15 tip rostral was advanced to lie in Bar. Extracellular single-unit recordings were made in Bar during continuous infusion (0.1 mL/min) of the bladder with saline or 0.2% acetic acid. Digital conversion of both unit activity and bladder pressure, data storage and analysis were carried out using a 1401+ conversion unit and Spike 2 software (Cambridge Electronic Design, Cambridge UK). At the end of the experiment, the brain was fixed in formalin, cut at 40um and stained with thionin for locating the recording site.

Results: We found minimum discharge rates of 0.1-5.9 Hz over a 20 sec period between micturition contractions during saline infusion into the bladder (n=8). Thus Bar units are not completely silent between bladder contractions in a constant infusion model. Acceleration of the discharge usually began within 7 sec of the micturition threshold as judged from the pressure trace and reached maximum (at 9.1 +/- 3.9 Hz (mean +/- SD)) during the peak micturition pressure. The elevated discharge rate usually returned to basal 1-5 sec before the pressure returned to baseline. During acetic acid infusions basal discharge rates were similar but maximum rates achieved during micturition were higher (16.5 +/- 8.4, n=9). The accelerated discharge often did not return to basal levels until after the pressure had returned to baseline (5 of 9 cases).

Conclusions: (1) Bar doesn't seem to act as a true switch because neurons are active in the filling period between micturition contractions when the bladder is not contracting. (2) In general, the activity of Bar units remains in the same relationship to bladder contractions during infusion with acetic acid as with saline. Thus Bar seems still to be responsible for the generation of bladder contractions in the inflamed state. However, there are some differences in the details of the relationship that may indicate that either Bar receives aberrant input after inflamation or a more distal mechanism alters the relationship between Bar discharge and the resulting bladder contraction. Supported by the Fishbein Family Interstitial Cystitis Foundation

MP-1.14

Experimental studies on the renal pelvic electromechanical activity

Shafik A.
Cairo University, Surgery and Experimental Research, Cairo, Egypt

Introduction & Objectives: The electromechanical activity of the renal pelvis was studied in dogs aiming at furthering the understanding of the mechanism of urinary flow through the renal pelvis and at identifying a normal electropyelogram (EPG) to act as a standard for the evaluation of abnormal ones.

Material & Methods: Under anesthesia, a loin incision was performed on 16 dogs and three monopolar electrodes were sutured to the upper, middle and lower third of the renal pelvis. The intrapelvic pressure was measured by a catheter which had 2 side ports and was connected to a transducer. The electromechanical activity of the renal pelvis was recorded at rest, upon renal pelvic distension, during renal vessel clamping and after renal pelvic myotomy and pyelectomy.

Results: Triphasic slow waves or pacesetter potentials (PPs) were recorded and were found identical in the 3 electrodes of the same renal pelvis. They were followed randomly by bursts of action potentials (APs). The APs were associated with rise of the intrapelvic pressure. Renal vessels clamping effected no significant changes in the electromechanical activity of the renal pelvis. Renal pelvic distension caused increase in the PP and AP frequency and amplitude. The electric waves were recorded from the electrode located proximally but not from those located distally to the myotomy indicating the caudad direction of the waves. No electric activity was registered after renal pyelectomy.

Conclusions: The PPs and APs seem to have a role in the contractile activity of the renal pelvis and in directing this activity towards the ureter. An EPG was characterized for the normal renal pelvis. It might show changes in renal pelvic pathologic conditions and is thus suggested to act as an investigative tool.

MP-1.15

Can povidone iodine be an alternative to silver nitrate for renal pelvic instillation sclerotherapy in chyluria?

Kumar A.
Sanjay Gandhi Post Graduate Institute of Medical Sciences, Urology and Renal Transplantation, Lucknow, India

Introduction & Objectives: To compare the efficacy and toxicity of 1% silver nitrate, 0.2% povidone iodine and 50% dextrose in renal pelvic instillation sclerotherapy (RPIS) for chyluria.

Material & Methods: In this prospective randomized comparative study, from January 1999 to June 2003, 106 patients (61 males and 45 females) of mean age 36 + 12 (range 14-65) years were included. Patients were randomized to receive 1% silver nitrate, 0.2% povidone iodine or 50% dextrose as RPIS. Total of 9 doses at 8-hourly intervals were given. Follow-up was done at 6 week and thereafter at 3-monthly interval. Patients with ?persistence? or ?recurrence? of chyluria were treated with second course of RPIS using same sclerosant.

Results: Dextrose arm was discontinued at mid-term due to poor success (1/21 patients, p<0.0001). Of 85 patients, 44 received silver nitrate and 41 received povidone iodine. Patients in both groups were well matched. The mean follow-up was 28.4 and 23.3 months in two groups respectively. ?Immediate clearance? was noted in 90.9% and 97.6% and recurrence was found in 20.5% and 22.0% patients following first course of RPIS in two groups respectively. Kaplan-Meier estimates of ?disease free duration? in two groups (23.6 vs. 20.1 months) were also similar (p=0.7906). Cumulative success rate following two courses of RPIS was 81.8% in silver nitrate group and 82.9% in povidone iodine group (p value=1.000). Five (11.4%) patients in silver nitrate group and one (2.4%) in povidone iodine group had significant pain in flank during the treatment.

Conclusions: Povidone iodine 0.2% is as effective an agent for RPIS as 1% silver nitrate.