Eur Urol Suppl 2011;10(2):118 (pT1-pT4) were staged with [11C] choline PET/CT before radical cystectomy and regional LN dissection. LNs were dissected from the internal and external iliac arteries up to the origin of the lower mesentery artery according to 14 predefined anatomical fields. Histopathological findings of resected lymphatic tissue were correlated with the results of [11C] choline PET/CT and CT alone in a patient and field-based manner. Results: LN metastases were found in 12/44 (27%) patients. On a patient basis sensitivity, specificity and accuracy for [11C] choline PET/CT was 58%, 66% and 64% - for CT 75%, 56% and 61%, respectively. 25/471 (5%) of dissected LN fields showed metastases. On a field basis sensitivity, specificity and accuracy for [11C] choline PET/CT was 28%, 95% and 91% while for CT 40%, 92% and 89% were calculated. Conclusions: In patients with bladder cancer scheduled for radical cystectomy pre-operative LN staging sensitivity was moderate on a patient level and low on a LN field basis with [11C]choline PET/CT and CT. [11C]choline PET/CT revealed no added value to CT. 318 THE IMPACT OF EARLY RE-RESECTION ON UPSTAGING AND UPGRADING ON RECURRENCES IN PATIENTS WITH HIGH GRADE NON-MUSCLE INVASIVE BLADDER CANCER Vasdev N., Dominguez-Escrig J., Thorpe A., Durkan G. Freeman Hospital, Dept. of Urology, Newcastle upon Tyne, United Kingdom Introduction & Objectives: The incidence of remnant residual tumour following initial TURBT in patients with high grade non-muscle Invasive bladder cancers (HG-NMIBC) can be as high as 33-53% of patients. Additionally, 10% of initial resections are deemed to be understaged. Current EAU 2010 guidelines envisage an early re-resection to be associated with an increase in recurrence-free survival. We aim to evaluate the impact of early re-resection on the incidence of recurrence and progression in patients with HG-NMIBC. Materials & Methods: From Jan 2001 – July 2008, 487 patients were diagnosed with HG-NMIBC. The histological diagnosis was confirmed by cross-reporting by at least two uropathologists. Retrospective data was collected which included patient demographics, histological parameters which included the presence of detrusor muscle at initial TURBT and re-resection, type of adjuvant intravesical therapy (BCG, MMC etc), recurrence and progression rates. Early re-resection was performed within 8 weeks of initial TURBT. SPSS and Graphad prism-5® software was used for statistical analysis. Results: Patients comprised of those who underwent an early re-resection (Group A) and those who did not (Group B). Group A (early re-resection) consisted of 172 patients with a mean age of 72 years (range= 44.6-91.2) at presentation amongst whom 80% were male. Group B (No re-resection) consisted of 315 with a mean age of 75 years (range= 39.9-100.2) amongst whom 76% were male. At initial TURBT detrusor muscle was present in 61% of patients in group A and 76% of patients in group B. 78% of patients had detrusor muscle on re-resection biopsies (group A). Additionally, the incidence of residual tumour was 54.6% (94/172) with the incidence of up-grading and up-staging being 20.2% and 12.7%, respectively. Fifty three (92) in group A and 58% (184) in group B received intravesical BCG. The recurrence rate of tumours within patients who received BCG was 50% (46/92) in group A and 54% (99/184) in group B (p=NS). The overall incidence of tumour recurrence was 35% in group A and 42% in group B. The rate of upstaging was in 1.2% of tumours in group A versus 20% in group B (p<0.05). Whereas, the rate of upgrading was 14.4% in group A versus 26% in group B (p=NS). Conclusions: Current EAU guidelines recommend early re-resection in the management of HG-NMIBC. Our results confirm the benefits of this approach and highlight a significant reduction in tumour up-staging in recurrences following re- resection. We hence advocate the implementation of an early re-resection in this subset of patients. 319 A NOVEL APPROACH TO DIAGNOSIS AND STAGING OF BLADDER TUMORS BY WATERJET HYDRODISSECTION Kugler M. 1 , Nicklas A. 1 , Walcher U. 1 , Imkamp F. 2 , Mikuz G. 3 , Herrmann T.R. 2 , Nagele U. 1 1 General Hospital Hall in Tirol, Dept. of Urology and Andrology, Hall In Tirol, Austria, 2 Hanover Medical School, Dept. of Urology and Uro-Oncology, Hanover, Germany, 3 Medical University Innsbruck, Dept. of Pathology, Innsbruck, Austria Introduction & Objectives: Transurethral resection is the standard procedure for the resection of bladder tumors but suffers from some disadvantages, e.g. the inability to assess the entire edge of resection or the lamina propria, thereby making the important differentiation between R0 and R1 resection almost impossible. Waterjet submucosal hydrodissection is an emerging new technology for endoscopic removal of gastrointestinal tumors promising to preserve the histological structures of biopsy specimen with favorable long term results as recent studies have shown. The aim of this study was to show its feasibility for removing and staging bladder neoplasms. Materials & Methods: Transurethral submucosal dissection was performed in five patients using a Hybrid-Knife and the waterjet-generator Erbejet-2 (Erbe, Tübingen). After labelling the edges of the resection by means of electrical coagulation, a submucosal fluid cushion specific to the tissue layer was formed, making an en-bloc dissection of the tumor as well as the bordering healthy appearing tissue possible. Separate biopsy specimens of the tumor edge and base were collected. An experienced pathologist analyzed all obtained samples. Results: In all specimens, the lamina propria was intact, allowing the pathologist to distinguish between superficial and invasive tumors, thus allowing the important assessment of muscle infiltration. Pathological analysis confirmed R0-resection in all samples and resulted in four pTa transitional cell carcinomas and one inverted urothelial papilloma. No complications occurred. Conclusions: These initial results show the practicality and feasibility of waterjet hydrodissection of bladder tumors and are promising in regard of an improved value of histopathological staging. In contrast to conventional TUR-B the pathologist can assess the entire lamina propria and the resection edges safely due to the en-bloc resection, thereby allowing the important differentiation between invasive and non- invasive tumors. Furthermore, due to the preservation of the histological structures the pathologist can make a definite assessment about the R0 vs. R1 resection, thereby decreasing the need for a Re-TURB. 320 A POPULATION-BASED COMPETING-RISKS ANALYSIS OF THE SURVIVAL OF PATIENTS TREATED WITH NEPHROURETERECTOMY (NU) FOR UPPER-TRACT UROTHELIAL CARCINOMA (UTUC) Sun M. 1 , Thuret R. 2 , Bhojani N. 3 , Jeldres C. 4 , Tian Z. 1 , Ismail S. 3 , Perrotte P. 3 , Karakiewicz P.I. 1 1 University of Montreal Health Center, Cancer Prognostics and Health Outcomes Unit, Montreal, Canada, 2 University of Montpellier Health Center, Dept. of Urology, Montpellier, France, 3 University of Montreal Health Center, Dept. of Urology, Montreal, Canada, 4 University of Montreal Health Dept. of Urology Center, Cancer Prognostics and Health Outcomes Unit, Montreal, Canada Introduction & Objectives: We sought to devise a tool capable of indicating the rates of cancer-specific mortality (CSM) and other-cause mortality (OCM) after nephroureterectomy for UTUC, according to patient age and disease stage. Materials & Methods: Relying on 17 registries from the Surveillance, Epidemiology and End Results database, 6078 patients with UTUC were treated with NU, between years 1988 and 2006. Patients were stratified according to age and tumor stage categories, which resulted in 20 strata. Poisson regression models were fitted to obtain estimates of CSM and OCM rates at five years after NU. Results: CSM was proportional to disease stage and OCM was proportional to patient age. CSM was stable across age categories in patients with localized disease (pT1-2N0/x) but increased according to age in patients with locally- advanced disease (pT3-4N0/x and pTanyN1-3). For example, in patients with pT4N0/x disease, the estimated five-year CSM rate increased from 19.9% in patients ≤59 years old to 29.1% in patients ≥80 years old (P<0.001). Conversely, the effect of OCM was more important in patients with localized disease relative to patients with locally-advanced disease. Conclusions: The current findings provide a clinically applicable and valuable graphical aid for prediction of CSM and OCM, according to UTUC disease stage and patient age. It may assist clinicians in better stratifying patients according to the risk-benefit ratio of NU. 321 RISK OF SECOND PRIMARY CANCERS AFTER URINARY BLADDER CANCER: AN ANALYSIS OF THE NETHERLANDS CANCER REGISTRY Ploeg M. 1 , Aben K.K.H. 2 , Ebben K. 3 , Witjes J.A. 1 , Kiemeney L.A.L.M. 4 1 Radboud University Nijmegen Medical Centre, Dept. of Urology, Nijmegen, The Netherlands, 2 Comprehensive Cancer Centre East and Radboud University Nijmegen Medical Centre, Dept. of Epidemiology, Biostatistics and HTA, Nijmegen, The Netherlands, 3 Comprehensive Cancer Centre East, Nijmegen, The Netherlands, 4 Comprehensive Cancer Centre East and Radboud University Nijmegen Medical Centre, Dept. of Urology and Dept. of Epidemiology, Biostatistics and HTA, Nijmegen, The Netherlands Introduction & Objectives: Familial clustering of urinary bladder cancer (UBC) suggested a genetic component for the risk of developing this disease. Genome- wide association studies led to the discovery of sequence variants in the human genome associated with UBC. More recent discoveries show that sequence variants in the region of particular genes are associated with the risk of many types of cancer. Due to these discoveries in the genetic field and for accurate counselling and follow-up, the knowledge of the risk of second primary cancers (SPCs) in UBC patients becomes more and more important. Materials & Methods: A population based cohort study was conducted using data from the Netherlands Cancer Registry. All patients diagnosed with UBC between 1-1-1989 and 31-12-2006 were included. Data were obtained concerning patient and tumor characteristics, primary treatment and vital status. Follow-up was completed until 1-2-2009. Standardized Incidence Ratios (SIRs) were calculated. Specific influences of gender, age at UBC diagnosis, primary treatment, morphology and stage of the bladder tumor on the development of SPC were also evaluated. Detection bias may artificially increase the risk of SPCs, e.g., coincident findings of prostate cancer in males treated with radical cystoprostatectomy. To prevent this