Eur Urol Suppl 2008;7(3):220 597 SIGMOID ORTHOTOPIC NEOBLADDER: LONG TERM URODYNAMICS RESULTS Della Melina A., Villari D., Castigli M., Mencarini M., Ringressi A., Li Marzi V., Filocamo M.T., Stomaci N., Nicita G. A.O.U. Careggi, S.O.D. Urology II, Florence, Italy Introduction & Objectives: To evaluate long-term urodynamic results using a 20-25 cm, completely detubularized sigmoid colon segment, remodelled in spherical shape, as an orthotopic continent reservoir Material & Methods: based on follow up. 6 months (96 pts–group A), 2 years (52 pts–group B), 5 years (44 pts - group C) Results: (45,4%) D 6 (54,5%). Data from micturition diary at 6 months, 2, 5 and 10 years of follow up show a mean daytime frequency of 8.4, 6.25, 5.2, 5.8 respectively. Group A (pts 96) Group B (pts 52) Group C (pts 44) Group D (pts 11) Q Max (ml/sec) 12.60 (7-21) 10.78 (8.2-14.6) Mean Voided volume (ml) Residual urine volume (ml) 78.15 (0-450) 49.17 (0-150) 61.11 (0-100) Max capacity (ml) 440.67 (200-680) Max P at Max capacity (cm/H2O) 42.75 (15-70) 29.78 (12-70) Max P Det (cm/H2O) 54.52 (15-140) 46.08 (15-80) 28.89 (15-55) 26.72 (18-45) Max P Det at Q max (cm/H2O) 71.67 (20-110) Voided volume, Max P Det, Max neobladder capacity and Max P Det at Max Capacity improve over Conclusions: Health-related quality of life after surgery is an important issue in the decision making process of urinary diversion following cystectomy. In our experience sigmoid neobladder allows in the long term period a good compliance with complete voiding and without severe reservoir dilatation as in the brief follow-up. 598 PREVENTION OF HYPERCONTINENCE AND PRESERVATION OF WOMANHOOD IN PATIENTS UNDERGOING CYSTECTOMY AND ILEUM NEOBLADDER CREATION FOR INVASIVE BLADDER CANCER BY PRESERVING THE VAGINA AND PERFORMING A COLPOSACROPEXY WITH TITANIUM COATED POLYPROPELENIUM MESH ALL IN A SINGLE SESSION: THE BERLINER NEOBLADDER Neymeyer J., Abdul–Wahab W., Beer M. Franziskus-Hospital-Berlin, Dept. of Urology and Urogynaecology, Berlin, Germany Introduction & Objectives: The gold standard treatment for invasive bladder cancer is a cystectomy and creation of an ileum neobladder, when possible. However, earlier techniques in women have yielded unsatisfactory results due to long term complications like hypercontinence which can be seen in up to 80% of patients. These techniques also included anterior excintration and hence prevented sexual intercourse. Therefore, our aim is to take these factors into consideration by preserving the vagina to aid in a normal sexual life and to perform a colposacropexy with a titanium coated polypropelenium mesh to prevent the development of prolapse and hypercontinence. Material & Methods: and meeting the criteria for cystectomy and neobladder creation were included in the study. These patients were subjected to a combined urological and gynecological approach simultaneously. The urological component consisted of a cystectomy, pelvic lymph node dissection and creation of an ileum neobladder and the gynaecological component consisted of a hysterectomy, oopherectomy, preservation of the vagina and most notably, colposacropexy with a titanium coated polypropelenium mesh. Results: Our combined surgical method has succeeded in preventing the development patients have been treated for their bladder cancer with this technique and none of addition, 19 patients accounting for 51% of the total have resumed full sexual activity. Conclusions: Preserving the vagina and performing a colposacropexy during cystectomy with ileum neobladder prevents hypercontinence and allows for normal sexual intercourse without forsaking the gold standard of oncology surgery in any way. 599 EXTENDED LYMPHADENECTOMY DURING RADICAL CYSTECTOMY WOULD BE BENEFICIAL ONLY IN PATIENTS WITH CLINICAL N0 DISEASE AND AN ABSENCE OF PALPABLE LYMPH NODES Park J., Kim S., Kim C.S., Ahn H. Asan Medical Centre, University of Ulsan College of Medicine Urology, Dept. of Urology, Seoul, South Korea Introduction & Objectives: We investigated whether extended lymph node dissection (LND) during radical cystectomy would increase the survival of patients with bladder cancer and grossly enlarged or palpable lymph nodes (LNs). Material & Methods: urothelial bladder cancer at our institute. Exclusion criteria included metastasis, death within postoperative 1 month and no LND. Data from 494 patients who underwent standard or extended the pathologic and gross nodal status. Mean follow-up was 44.7 months (range 2-205). Results: The overall 5-year CSS and RFS were 67.4% and 58.1%, respectively. In N- patients, p=0.017). However, in N+ patients, more LND did not have an impact on patient survival (5-year gross nodal status was analyzed according to pathologic N stage, most of gross N+ disease with N2 or higher disease. Conclusions: Removal of more LNs would provide survival advantage when preoperative clinical stage is N0 and there is no palpable LN enlargement found intraoperatively. However, extensive lymphadenectomy in patients with clinically N+ disease or palpable LNs found during surgery 600 LAPAROSCOPIC NEPHROURETERECTOMY WITH RESECTION OF THE DISTAL URETER AND BLADDER CUFF IN OPEN SURGERY: ANALYSIS OF THE SAFETY AND ONCOLOGICAL OUTCOMES IN AN ITALIAN MULTICENTRIC STUDY Porpiglia P. 1 , Guazzoni G. 2 , Malossini G. , Billia M. 1 1 , Cracco C. 1 , Luciani L. , Cestari A. 2 , 2 , Scarpa R.M. 1 1 San Luigi Hospital, University of Turin, Division of Urology, Orbassano, Italy, 2 Division of Urology, Milan, Italy, Santa Chiara Hospital, Division of Urology, Trento, Italy Introduction & Objectives: Laparoscopic nephroureterectomy (LNU) is today considered as a valid option in the management of upper tract transitional cell carcinoma (TCC) in experienced centres. Few series of LNU have shown oncological results that equal those of open nephroureterectomy and to extract the specimen are still controversial. Aim of this multicentric study was to evaluate the clinical and oncological outcomes of LNU with open distal ureterectomy for upper tract TCC. Material & Methods: Data regarding 50 patients who underwent a LNU with a transperitoneal or Pfannesteil incision, preserving the integrity of the urinary tract. Loco-regional lymphadenectomy was performed in selected cases (laparoscopically if the tumour was localized in the renal pelvis, calyces or upper ureter, surgically if the tumour was localized in the pelvic ureter). The patients were followed with serial CT scan and US, chest x-ray, urinalysis and urinary cytology. Demographic, clinical and pathological data including age, gender, BMI, tumour side, location and size on the surgical specimen, complications, margins of resection, histology and oncological follow-up were collected for each patient. The Kaplan-Meier method was used to evaluate overall and disease-free survival. Results: 45 TCCs were monolateral(21 left and 24 right) and 5 were bilateral. Mean diameter complications occurred in 4 cases(8%): 2 acute bleedings that required conversion, 1 vascular injury controlled in laparoscopy and 1 bleeding that needed blood transfusion. Postoperative complications and one for acute pulmonary embolism. No patient developed local recurrence. TCC recurred in the bladder in 12 patients(24%). Only one patient developed contralateral TCC at follow-up. Disease-free survival was 76%. Conclusions: seedings in this multicentric series. Tumour related deaths are due to systemic progression or bladder recurrences of TCC.