Eur Urol Suppl 2009;8(4):304 734 GUnSHOT WOUndS TO THe MaLe exTeRnaL GenITaLIa - 9 YeaRS and 70 caSeS In cape TOWn Van Der Merwe A. 1 , Tyler F.C. 2 , Pontin A.R. 2 1 University of Stellenbosch, Dept. of Urology, Cape Town, South Africa, 2 University of Cape Town, Dept. of Urology, Cape Town, South Africa Introduction & Objectives: This is a retrospective study of male patients that sufered gunshot wounds to the external genitalia from August 1997 to September 2006. This study also reviews the literature and compares treatment methods locally and internationally. Material & Methods: Surgical Research Committee – and Ethical Committee approval was obtained. In total, 70 patient case notes were reviewed. Demographic- and socio economic data (age, race, area of residence, marriage status, employment, possible relationship problems) were collected. Data regarding number and position of gunshots to genitalia were collected as well as associated injuries. The position of the penile injury as well as spermatic cord and testicular injuries were documented. Urethral injuries were documented according to the anatomical divisions of the urethra. The velocity of the missile was documented. Urine dipstick at initial evaluation was documented. Management at Groote Schuur Hospital, early and late complications (with special reference to erectile function) were studied. Results: Only one case involved a high velocity gunshot wound. The majority patients were Black (37 cases) (53%), unemployed (42 cases) (60%), and single (51 cases) (82%) in the 20-30 (29 cases) (40%) year old age group. The bulk of injuries took place during November and December months. The highest education that any patient had was a salesman. The townships of Khayelitsha and Mitchell’s Plain produced the most referrals to Groote Schuur Hospital. Urine dipstick test were positive in 14 patients of whom only three had urethral injuries on further investigation. Four cases were investigated with micturating cysto-urethrography (MCUG) diagnosing one urethral injury. The scrotum was most commonly afected (24 cases), followed by penoscrotal (23 cases), and penile (23 cases). Of fourteen urethral injuries seen seven were treated with primary closure and one developed a stricture. The seven other urethral injuries were treated by urine diversion alone – one patient developed a stricture, but follow up was relatively short. Three cases needed bilateral orchidectomy. One patient with a penile gunshot developed chordee that spontaneously resolved on follow-up. One patient had poor erections and was treated with a vacuum device before disappearing from follow-up. conclusions: This study relate unmarried state and poor social circumstances to being risk factors for gunshot wounds to the genitalia and identifed certain areas in Cape Town and certain months of the year where these injuries were more frequent. Urethral and corporeal injuries were relatively free of complications. The author concurs with current literature that early complete debridement and primary closure of all afected tissues including the urethra is optimal management to reduce the complication rate. Anatomical diagnosis is crucial to manage these injuries correctly. Follow up in this patient group was poor. 735 ManaGeMenT OF IaTROGenIc UReTeRIc InJURIeS In aBdOMInOpeLvIc and endOUROLOGIcaL SURGeRY Yapanoglu T. 1 , Aksoy Y. 1 , Aydın H.R. 1 , Ozturk M. 2 , Ozbey I. 1 1 Ataturk University, School of Medicine, Dept. of Urology, Erzurum, Turkey, 2 Haydarpasa Numune Hospital, Dept. of Urology, Istanbul, Turkey Introduction & Objectives: To investigate the incidence, etiological factors, and the efect of early diagnosis and surgical treatment on the outcome of iatrogenic ureteric injuries treated in our urology unit over an 8-year period. Material & Methods: A retrospective review was performed on all patients referred for management of an iatrogenic ureteric injury from 1998 to 2006. Data collected and analyzed included incidence of injury, etiological factors, modalities of treatment and the outcome of management of the injuries. Results: There were 56 iatrogenic ureteric injuries in 52 patients over the 8-year period. Urological, obstetrical, gynecological and general surgical procedures were involved in 14 (25 %), 6 (10.7 %), 30 (53.5 %) and 6 (10.7 %) of the injuries, respectively. The commonest types of injuries encountered were ureteral ligations. The commonest treatment option used was end–to- end anastomosis. Ten patients were treated using the Boari bladder fap, 6 by ureteroneocystostomy, 18 by end-to-end anastomosis, 8 by deligation, 11 by double-J stent insertion and 2 patient was followed conservatively. One patient underwent nephrectomy. The overall successful resolution of ureteric injuries in this series was 55/56 (98.2 %). There was no mortality attributable to these ureteric injuries. conclusions: Iatrogenic ureteric injuries are globally rare but are liable to occur due to the inherent ureteric anatomic factors in the pelvis. The practical principles for the prevention and repair of ureteric injuries are presented and discussed. The true risk to the patient lies in delayed, missed diagnosis and inadequate treatment. Despite preoperative studies and intra-operative inspection, ureteral injury may remain undiagnosed until after abdominopelvic surgery. Early detection and appropriate management ensure successful recovery. 736 FaILURe OF nOn-OpeRaTIve ManaGeMenT In GRade III BLUnT RenaL InJURIeS: a FIFTeen YeaR RevIeW Serafetinides E., Philippou P., Volanis D., Ploumides A., Kardakos I., Delakas D. Asklepeion Voulas General Hospital, Dept. of Urology, Athens, Greece Introduction & Objectives: Renal trauma is reported in 3% of trauma patients and in more than 90% is due to blunt mechanisms of injury. Conservative management is the treatment of choice in stable patients, although some require a delayed surgical intervention as result of their injuries. The aim of our study was to highlight potential risk factors in conservative management of patients with blunt renal injuries. Material & Methods: A retrospective review of 235 patients who were admitted with Grade III blunt renal injuries between January 1993 and December 2007 was performed. Patients underwent clinical assessment, laboratory tests and radiographic staging. Patient charts were reviewed to determine sex, age, mechanism of injury, time of transfer, vitals, frst documented value of Hgb, presence of macroscopic haematuria, need for transfusion, imaging, associated injuries, management, surgical fndings and outcomes. Results: A total of 75 patients (32%) had additional extra-abdominal organ injuries. Patients were broken down into two groups based on whether they were managed conservatively or surgically. Overall exploration rate was 8%. In 216 patients (Group A) expectant management resulted in safe recovery with preservation of renal function. Nineteen patients had a delayed surgical exploration within 5 days (Group B) and 12 renal units were lost while 6 patients underwent renorrhaphy and 1 partial nephrectomy. Statistically signifcant predictor of failure of conservative management was a coexisting solid organ intra-abdominal injury requiring surgery and the low initial value of Hgb. Sex (females), young age and macroscopic haematuria at presentation were good prognosticators for conservative management. In addition transfusion needs were higher in Group B and during exploration most patients had multiple parenchyma lacerations. There was a 26.3% complication rate following surgery. The overall mean hospital stay was 11.7 days and was similar across both groups. conclusions: Hemodynamic instability is the key factor for exploration of renal injuries. The non-operative treatment approach was more common in the last seven years compared to the previous eight years. Factors such as sex (males), age (older people), initial value of Hgb, associated injuries requiring operation and multiple renal parenchyma lacerations predict a failure of conservative management. Operative strategy should be conservative unless the kidney is unsalvageable. Grade III blunt renal injuries managed conservatively is not associated with complications in the haemodynamically stable patient. 733 MORTaLITY pRedIcTIOnS In paTIenTS WITH adRenOcORTIcaL caRcInOMa Zini L. 1 , Cloutier V. 1 , Arjane P. 1 , Capitanio U. 2 , Jeldres C. 1 , Isbarn H. 1 , Shariat S.F. 1 , Duclos A. 1 , Widmer H. 1 , Saad F. 1 , Perrotte P. 1 , Briganti A. 2 , Gallina A. 2 , Suardi N. 2 , Montorsi F. 2 , Karakiewicz P.I. 1 1 Cancer Prognostics and Health Outcomes Unit, Dept. of Urology, Montreal, Canada, 2 Vita-Salute San Rafaele, Dept. of Urology, Milan, Italy Introduction & Objectives: The cancer-specifc and overall mortality of patients with adrenocortical carcinoma (ACC) may be quite variable. We developed nomograms predicting ACC-specifc and overall mortality in patients managed with either surgery or no surgery for ACC. Material & Methods: The models were developed in a cohort of 205 ACC patients and externally validated it using a cohort of 207 ACC patients, identifed in the 1973-2004 Surveillance, Epidemiology and End Results (SEER) database. The predictors consisted of age, gender, race, stage and surgery status. Nomograms based on Cox regression model-derived coefcients were used for prediction of the ACC-specifc and overall mortality, and were tested using area under the Receiver Operating Characteristics (ROC) curve. Results: In cancer-specifc analyses, the median survival of patients within the development cohort was 26 vs. 71 months in the external validation cohort (P<0.001). In overall survival analyses, the median values were 21 vs. 32 months for respectively the development and the external validation cohort (P<0.001). Three variables (age, stage and surgical status) were included in the nomograms predicting cancer-specifc and overall mortality. In the external validation cohort, the nomograms achieved between 72 and 80% accuracy for prediction of ACC-specifc or overall mortality at 1 to 5 years after either surgery or diagnosis of ACC for non-surgical patients. conclusions: Our models are the frst standardized and individualized prognostic tools for patients with ACC. Their accuracy was confrmed within a large external population-based cohort of ACC patients.