The first abstract in this session by the group from the Children's Hospital Boston, Boston, MA, USA was to investigate the EGF receptor (EGFR) signaling and its modulation to identify novel therapeutic strategies. Bladders from female rats were distended in vivo to 40 cm H2O with KGM/2% FBS +/- 10µM EGFR inhibitor ZD1839 (gefitinib, Iressa). The bladders were excised and incubated ex vivo in DMEM/10% FBS for 4-24h. Shams were performed. The group showed that EGFR activation in the detrusor following over-distention is associated with an increase in detrusor DNA synthesis and a reduction in cell death.

The next abstract by Thomas et al from Vanderbilt Children s Hospital, Nashville, TN, USA showed that Angiotensin II (AT2) antagonism reduces fibrosis in the rat bladder following partial outlet obstruction. The group concluded that partial bladder outlet obstruction in the rat causes smooth muscle hypertrophy and ECM deposition in the lamina propria brought about in part by increased TGF- 1 expression. Blockade of AT2 reduces fibrosis by decreasing TGF- 1 downstream signaling. The following abstract by Metcalfe et al, retrospectively reviewed the first 500 bladder augmentations, performed from 1978-2003, at Riley Hospital with a mean follow-up of 12.8 years. They explained how bladder augmentation provided improvements in quality of life, but required lifelong dedication from the patient, family and health care providers. While the majority was performed without serious complications, the requirements for additional surgery are not trivial.

Next, Yutaka Hayashi and colleagues from Tokyo, Japan reviewed neurogenic bladder patients who had sigmoidocolocystoplasty with a follow-up of more than 10 years. They had 86 patients who underwent sigmoidocolocystoplasty for neurogenic bladder and were reviewed with respect to histopathology of the neobladder, renal function, recurrence of vesicoureteric reflux, incidence of bladder stones, and improvement in urinary continence. Their results suggested that sigmoidocolocystoplasty is safe and effective for the management of the neurogenic bladder in the long-term.

The next abstract by Nelson et al was prospective randomized study describing the in vivo and in vitro characteristics of each bowel segment utilized for cystoplasty. Nine male dogs underwent preoperative urodynamics and were randomized to gastric, ileal and sigmoid cystoplasty. Compliance in all 3 groups was not statistically different. In vitro testing on a stretch apparatus confirmed that there was no difference among groups in terms of: maximum load, tensile stress at maximum load, e-modulus and tensile stress at break point. The group concluded that augmentations should be chosen by patient s metabolic concerns, availability of GI segments or surgeon preference and not by concerns for compliance where equivalent sized segments can be used.

The following abstract by Estrada et al from Children s Hospital Boston, Boston, MA, USA was to determine the risk of UTI and whether a postnatal VCUG and/or DMSA scan should be performed in patients with mild-moderate hydronephrosis. From a prospective database of all patients with PNH maintained since 1998, they identified those with Society for Fetal Urology hydronephrosis greater than or equal to 3. This cohort was divided into those who did and did not receive an initial VCUG. The rates of VUR and development of UTI were determined. The presence of DMSA abnormalities was also assessed. They found that in patients with Society for Fetal Urology hydronephrosis greater than or equal to 3, identification of VUR and use of prophylactic antibiotics appears to reduce the risk of UTI. In addition, in patients with VUR, DMSA abnormalities are found in a majority, underscoring the value of a baseline renal scan in these patients if future DMSA scans are indicated. Therefore, they recommended that VCUG be performed in these patients and a DMSA obtained in patients with VUR.