262 THE JOURNAL OF UROLOGY ® Vol. 179, No. 4, Supplement, Monday, May 19, 2008 750 PERINEAL URETHROSTOMY WITH BUCCAL MUCOSA GRAFT: A NOVEL TECHNIQUE Timothy O Davies*, Jennifer L Bepple, Tyler Roseman, Gerald H Jordan. Norfolk, VA. INTRODUCTION AND OBJECTIVE: Reconstruction for urethral stricture disease has improved dramatically over the last 15 years. However, perineal urethrostomy is an excellent solution for those patients who are not candidates for complex reconstructive procedures. Techniques for the performance of perineal urethrostomy developing just distal to the external sphincter can be especially reconstruction of the urethra to a perineal neomeatus. We have reviewed our results of these patients. METHODS: Retrospective chart review was performed for those patients who had undergone the above mentioned procedure using dorsal buccal mucosal graft onlay. All of these procedures were not as part of a staged procedure. All patients who had undergone the procedure were included in the analysis. RESULTS: 12 patients underwent reconstruction to perineal neomeatus as mentioned in the methods. Median age of the patients was 63 years of age(44-78). All were performed for panurethral stricture disease involving the proximal bulbous or membraneous urethra. The cause of the stricture was hypospadias in 3, lichen sclerosis(LS/BXO) in 4, Fournier’s gangrene in 1 and unknown in 4. All patients were voiding months(6-48). One patient complained of buccal donor site issues. One patient had a single dilation of the perineal neomeatus 6 months post procedure and is now voiding well 18 months post dilation. 3 patients, not included in this series, had reconstruction to a perineal neomeatus CONCLUSIONS: Proximal urethral stricture disease is a results in a recurrent stricture at the level of the skin. Using a buccal mucosal graft in a dorsal onlay fashion to create a perineal neomeatus in this series provided good mid term success. This may be especially useful in those patients with LS/BXO in which using perineal skin is reconstructed had had multiple prior surgeries and likely did not have Source of Funding: None 751 INTRA-OPERATIVE ULTRASOUND INFLUENCES THE MANAGEMENT OF ANTERIOR URETHRAL STRICTURES Alex K Wu, Jill C Buckley*, Jack W McAninch. San Francisco, CA, and Burlington, MA. INTRODUCTION AND OBJECTIVE: Intra-operative ultrasonourethrography has previously been described as an effective and precise imaging modality for determining the length of anterior urethral strictures. We routinely perform intra-operative urethral sonography to better interrogate the character and length of urethral stricture to guide our reconstructive approach. To demonstrate its utility, we sought to quantitate how often intra-operative sonourethrography either determined or changed our operative approach in complex anterior urethral reconstructions. METHODS: A retrospective review of 500 patients receiving anterior urethroplasty from 1985 to 2007 was conducted. 232 patients met the inclusion criteria of documented pre-operative clinical assessment, retrograde urethrogram (RUG), intra-operative sonourethrogram, and measured operative stricture length. Immediately prior to urethral reconstruction, an intra-operative sonourethrography was preformed and the operative approach was selected based on sonourethrography in anterior urethral stricture reconstruction, we compared the pre-operative planned reconstructive approach to the preformed reconstructive procedure. Continuous and categorical data were compared using Mann-Whitney U and Chi-squared tests for RESULTS: Of the 232 patients in our review, 115 (50%), 88 (38%), and 16 (7%) received end-to-end anastomosis, buccal mucosa length was 2.9 cm (range 0.3 to 15 cm). Intra-operative ultrasonography changed surgical approach in 44 (19%) patients, and was integral in deciding between two equally possible approaches in an additional 61 (26%) patients. In patients whose approach was changed from end-to- end anastomosis to buccal mucosa graft, mean RUG length was 2.0 cm, When surgical approach was changed from buccal mucosa graft to end- to-end anastomosis, mean RUG length was 2.7 cm, but mean ultrasound CONCLUSIONS: Intra-operative ultrasonography of the in 45% of patients. It is a simple, quick procedure that adds valuable clinical and radiographical data that can be instrumental in selecting the optimal urethral reconstructive approach. Source of Funding: None Bladder Cancer: Basic Research (I) Moderated Poster Session 26 Monday, May 19, 2008 10:30 am - 12:30 pm 752 REGULATION OF BLADDER TUMOR MARKER, HYAL1 HYALURONIDASE: IMPLICATIONS IN DIAGNOSIS AND THERAPY Pablo Gomez*, Mario W Kramer, Luis Lopez, Murugesan Manoharan, Mark S Soloway, Vinata Lokeshwar. Miami, FL. INTRODUCTION AND OBJECTIVE: Hyaluronic acid (HA), is a glycosaminoglycan which promotes tumor metastasis. HYAL1 is the major Hyaluronidase expressed in tumor cells and degrades HA. We have shown that HYAL1 and HA are accurate diagnostic urine markers (HA-HAase test) for detecting bladder cancer. Our work has also shown that HYAL1 is a molecular determinant of tumor growth, angiogenesis and invasion. Currently, little is known about HYAL1 regulation. In this study, we evaluated the mechanism of HYAL1 regulation in bladder tumor tissues, cloned the HYAL1 promoter and studied its regulation. METHODS: In normal (n=27) and bladder tumor (n=42) tissues, HYAL1 mRNA expression was evaluated by real time RT-PCR and HAase activity by the HAase test. HYAL1 promoter was cloned into a luciferase-reporter vector from a 1.5 kb human HYAL1 genomic DNA fragment. Ppromoter-reporter constructs were tested in bladder cancer cell lines by luciferase assay. Several bladder cancer cell lines which do not express HYAL1, were treated with a DNA-demethylating agent KB inhibitor, Parthenolide. HAase activity and HYAL1 expression were examined by the HAase test and real time RT-PCR, respectively. RESULTS: HYAL1 mRNA expression was ~ 12-fold elevated in bladder tumor tissues when compared to normal tissues (P < 0.0001) and the increase correlated with HAase activity. Luciferase promoter-reporter assays showed that the HYAL1 promoter lies in a 55 base sequence that contains a TACAAA box and binding motifs for transcription factors SP1, EGR1, AP-2 and NFkb/p65. HYAL1 promoter contained a total of 6 CpGs, some of which are important for the promoter HYAL1 expression by 5-7-fold and Parthenolide attenuated HYAL1 promoter-reporter activity by ~ 80%. CONCLUSIONS: HYAL1 expression in bladder tumor tissues is controlled at the transcriptional level. Analysis of HYAL1 promoter should provide an insight into the regulation of this cancer marker, and a molecular determinant of bladder cancer progression. DNA methylation and NF KB appear to play a role in the regulation of HYAL1 expression. Source of Funding: Grant Support: NIH/NCI RO1 072821-09 (VBL).