Eur Urol Suppl 2007;6(2):65 169 COMPARISON bETWEEN ElECTIvE ANd IMPERATIvE NSS PROCEdURES REgARdINg MORbIdITY ANd CANCER CONTROl Patard J.J. 1 , Crepel M. 1 , Bernhard J.C. 2 , Ferriere J.M. 2 , Bellec L. 3 , Soulie M. 3 , Albouy B. 4 , Pfster C. 4 , Lacroix B. 5 , Tostain J. 5 , Lopes D. 6 , De La Taille A. 6 , Salomon L. 6 , Abbou C. 6 , Pantuck A.J. 7 , Belldegrun A. 7 , Colombel M. 8 1 Rennes University Hospital, Urology, Rennes, France, 2 Bordeaux University Hospital, Urology, Bordeaux, France, 3 Toulouse University Hospital, Urology, Toulouse, France, 4 Rouen University Hospital, Urology, Rouen, France, 5 Saint Etienne University Hospital, Urology, Saint Etienne, France, 6 Henri Mondor University Hospital, Urology, Creteil, France, 7 UCLA, Urology, Los Angeles, United States of America, 8 Lyon University Hospital, Urology, Lyon, France Introduction & Objectives: To compare through a large multicenter NSS series, morbidity and outcome in relation to indication (elective vs imperative). Material & Methods: This study included patients from 8 international academic centers. Elective and imperative indications (unique kidney, compromised renal function, bilateral tumours) were compared for the following variables: age, ECOG- PS, symptoms at presentation, ASA score, T stage, tumor size, histology, Fuhrman grade, operative time, medical and surgical complication rates, mean blood loos, blood transfusion, length of hospital stay, post-operative serum creatinine, overall and cancer related death rates. Qui-square and Student t tests were used for comparing qualitative and quantitative variables, respectively. Results: 839 partial nephrectomies were analysed, including 550 elective (65.6%) and 289 imperative (34.4%) indications, respectively. Patients operated for an imperative indication were older, had a poorer performance status and signifcantly more associated co-morbidities (p<0.01). Tumours were also greater in size, of higher grade (p<0.01) and were more often classifed as clear cell carcinomas in the imperative group (p:0.02). Although overall surgical complication rate was not signifcantly increased, mean operative time, mean blood loss, blood transfusion and medical complication rates were signifcantly increased for absolute indications (p<0.01). Finally, both cancer specifc survival and renal function outcomes were signifcantly altered in the imperative group compared to the elective one (p<0.01). Conclusions: When reporting about NSS results it is necessary to separate elective from imperative indications. From our study, it is obvious that patients, tumours, morbidity and outcomes are all signifcantly diferent when comparing NSS performed for elective or absolute indications. 170 lONg-TERM RESUlTS OF SIMPlE ENUClEATION FOR ThE TREATMENT OF SMAll RENAl CEll CARCINOMA Pertia A., Managadze L. National Center of Urology, Oncological Urology, Tbilisi, Georgia Introduction & Objectives: We analyzed our institutional experience with simple enucleation for the treatment of small renal tumors for elective indications. Material & Methods: A total of 44 patients underwent elective nephron-sparing surgery (NSS) from May 1997 to January 2001. All patients underwent NSS by means of enucleation. The tumor bed was coagulated carefully for haemostatic and partly for oncological reasons. Median follow-up was 71 months (range: 49-91 months). Results: Pathological review according to the 2002 TNM classifcation showed that 70% (31 of 44) of tumors were pT1a, 27,3 % (12 of 44) pT1b and in one case pathological T3a case was revealed by the microinvasion of the surrrounding perirenal fat Median tumor size was 3,7cm. (range: 3.0-5,5cm). Grade1 was diagnosed in 18 (40%) cases, Grade 2 in 22 (50 %) cases and Grade 3 in 4 (10%) cases. Histological classifcation revealed 32 clear cell (72,7%), 8 papillary (18,2%), 3 chromophobe (6,8%) and 1 cystic (2,7%) RCCs. There was no perioperative mortality (within the frst 30 days). Bleeding had not been recorded during perioperative period. Urinary leakage was observed in 1 patient (2,7%). No case of local recurrence was observed. One patient with pT1b, G3 disease developed osseous metastases and died 81 months postoperatively. One patient died for unrelated to kidney cancer reason without evidence of tumor recurrence. Five and 7-year cumulative survival was 97,7% and 95,4%, respectively. Five and 7-year cancer specifc survival was 100% and 97, 6%, respectively. Conclusions: Simple tumor enucleation is a safe and acceptable approach for elective NSS. It provides excellent long-term progression-free and cancer specifc survival rates, and is not associated with an increased risk of local recurrence compared with partial nephrectomy. P9 bPh: EvAlUATION Wednesday, 21 March, 14.30-16.00, Room 6 171 ESTAblIShINg NORMAl REFERENCE RANgES FOR PROSTATE vOlUME ChANgE WITh AgE IN A COMMUNITY-bASEd SAMPlE OF MEN AgEd 50-78 YEARS Bosch J.L.H.R. 1 , Tilling K. 2 , Bohnen A. 3 , Donovan J. 2 1 University Medical Centre Utrecht, Urology, Utrecht, The Netherlands, 2 University of Bristol, Social Medicine, Bristol, United Kingdom, 3 ErasmusMC, General practice, Rotterdam, The Netherlands Introduction & Objectives: Average trends of prostate volume growth have been established previously in closed cohorts of men. We aim to establish the normal pattern of prostate volume increase with age to predict the future prostate volume in individual men. Knowing with reasonable confdence how big a prostate will be 10 years or more from now, will help to make decisions about prevention of disease progression in men with minor or moderate LUTS who presently are candidates for watchful waiting. Material & Methods: In a community-based study, prostate volume was determined with transrectal ultrasound using the planimetric technique, at baseline and after 2.1 and 4.2 years, in men without prostate cancer. Prostate cancer was excluded using the ERSPC- biopsy protocol. At baseline, second and third follow-up, 1439, 1067 and 816 men had TRUS volume measurements, respectively. A multivariate multilevel growth curve model was used to estimate the pattern of change of prostate volume with age. It is assumed that each man has his own prostate volume pattern and that these true patterns vary about the population average. The model allows observed volumes to difer, even among men with the same characteristics. Additionally, the model allows volume for each man to vary about his true values, because of measurement error. All men with at least one measurement contribute to the model. The frst model ftted included age, body mass index and IPSS as explanatory variables and logProstate volume and logPSA as outcome variables Results: The fnal model showed that prostate volume was related to age only. The future prostate volume of an individual can be predicted based on his age and known history of prostate volume. The model can be used to calculate time needed for men with diferent prostate volumes at diferent ages to increase with a certain percentage. For example: in a man with a total prostate volume of 30 cm3 at age 50, the estimated time to an increase of 25% is 7.6 yrs. Similarly, in a man with a transition zone volume of 10 cm3 at age 50, the estimated time to an increase of 25% is 6.5 yrs. Furthermore, total prostate volume and transition zone volume increased by 2.2% and 3.6%, respectively, per year increase in age. Conclusions: This method establishes normal prostate volumes by age using prostate volume history in men without prostate cancer. The model provides baseline data from which future prostate volume can be predicted and disease progression can be detected. 172 ThE INFlUENCE OF PATIENT’S OR gP’S COPINg STYlES ON gENERAl PRACTITIONER’S INITIAl MANAgEMENT IN MEN WITh lOWER URINARY TRACT SYMPTOMS: ThE kRIMPEN STUdY Kok E. 1 , Bohnen A. 1 , Groeneveld F. 1 , Thomas S. 1 , Bosch R. 2 , Krimpen Study 1 Erasmus MC, Department of General Practice, Rotterdam, The Netherlands, 2 UMC Utrecht, Department of Urology, Utrecht, The Netherlands Introduction & Objectives: Coping is the way one deals with problems in general. We tested the hypothesis that diferent coping styles of patients or general practitioners (GPs) result in diferent treatment decisions (watchful waiting versus pharmacological treatment or referral to urologist) in men with lower urinary tract symptoms (LUTS). Material & Methods: A longitudinal, population-based study was conducted among 1688 men aged 50 to 78 years old. At baseline and during follow-up data were collected on quality of life and symptom severity based on the International Prostate Symptoms Score (IPSS). Data on coping styles were collected during the last follow-up using the Utrecht Coping List (UCL). Information on primary care seeking for LUTS and GP’s initial management during 6.5-years follow-up of all participants was collected from the GP records. Additionally, 86 GPs from Rotterdam and surroundings were asked to complete 16 hypothetical patient-cases for a 68-year-old man difering with regard to the severity, duration and perceived bother of LUTS as on the way the patient copes with problems in general. Data on GP’s age, gender, practical experience, knowledge and coping (UCL) were collected. Multiple logistic regression analysis was used to determine the infuence of patient’s and GP’s coping styles on GP’s initial management. Results: 160 men (10.6%) visited the GP for LUTS for the frst time during the 6.5-year study period; 68 of these men participated in the last follow-up round and completed the coping questionnaire. Men with a poorer disease-specifc quality of life (QOL) received treatment more often than men with a good disease-specifc QOL. Conversely, men with a poorer disease- specifc QOL who use the coping style ‘Passive reaction pattern’ received treatment less frequently than men not using this coping style (OR=0.86). 45% of the GPs completed the 16 cases and questionnaires. Severity, duration and patient’s perceived bother of LUTS, as patient’s coping behaviour were signifcantly associated with “treatment given less frequently”. The GP’s expected efcacy of medication is signifcantly associated with “treatment given more often”. GP’s coping style does not infuence his initial management in men with LUTS. Conclusions: In men with a poor disease specifc QOL patient’s use of the coping style ‘Passive reaction pattern’ largely infuenced GP’s initial management in men with LUTS. Therefore, correct estimation of patient’s coping style for daily practice is important. As the coping style of the GP himself has no impact on his initial treatment decision our fnding suggests that diferent GPs treat identical patients equally. In addition, urologists should be aware that the coping style of the patient is one of the factors that lead to referral of the patient by the GP.