iliac stenosis that required dilatation.Overall results: mean time to reach nor-mal renal function (creatinine �2mg/dl)was 22 days. There were three deaths:one postoperatively, one two years afterthe implant with no renal function, andone with normal renal function. Graft sur-vival at 1 and 5 years is 85 and 72% re-spectively. Patient survival is 95% at oneyear, remaining stable at 76% from the2nd year of follow-up.Conclusion: Third kidney transplant is agood therapeutic option for patients withtwo previous graft losses. Early and latecomplications were not different from 1st

and 2nd implants in our series. The re-peated use of the iliac fossa has not impli-cated more surgical complications in ourexperience.

PD-09.07Single or double kidney transplant?De La Rosa F1, Rodriguez A1, PamplonaM1, Villacampa F1, Passas J1, Andres A2,Praga M2, Aguirre JF1, Diaz R1, Leiva O1

1Urology Service and 2Nephrology Ser-vice, Hospital Universitario 12 de Oc-tubre, Madrid, Spain

Introduction: Today there are no defini-tive and solid criteria of when and how touse kidneys from cadaveric older donors.We have chosen a protocol that mixespathologic and functional criteria and do-nor age. In this paper, we present ourprotocol and outcome of our series.Methods: In December 1996, our groupstarted a protocol to optimize the use ofkidneys from cadaveric older donors. Theprotocol is as follows: a renal biopsy wasmade in all the kidneys. A double kidneytransplant was made if: a) donors wereover 75 years and renal biopsy showedless than 50% glomerulosclerosis (GE); orb) donors were between 60 and 74 yearsand renal biopsy had between 15 to 50%GE. A simple kidney transplant was per-formed when grafts were from donorsbetween 60 and 74 years and the biopsyhad less than 15% GE. Receptors of theseimplants were also elderly patients. A de-scriptive analysis of the results was made.Results: 304 (30.4%) out of 1000 kidneytransplants performed in our centre (De-cember 1996–December 2004) were fromdonors over 60 years old. 82 were doubleand 222 single. Mean donor age of the dou-ble and single transplants series were 75and 68 respectively. Immunosuppressionwas done with triple therapy(steroids�MMF� cyclosporine/tacrolimus).Actuarial graft survival at 4 years is 79% forthe double transplant group and 78% forthe single group (excluding death of pa-

tients with functioning kidney). With 4years of follow-up, mean serum creatinine is1.8 mg/dl (�0.9) for the double implantseries and 2.1mg/dl (�0.7) for the single.Conclusions: The results of grafts from olderdonors, used either in a single or double fash-ion, are excellent. Our protocol, using frozenrenal biopsies of the kidneys and donor age,allows us to optimize these grafts, with guar-antees of good long-term outcome.

PD-09.08Graft loss during the first year afterrenal transplantationParada B, Figueiredo A, Nunes P, MoreiraP, Rolo F, Mota ADept. of Urology and Renal Transplanta-tion; Hospitais da Universidade de Coim-bra, Portugal

Introduction: To study the renal graftslost during the first year after the trans-plant.Methods: We analyzed 1420 renal trans-plants done in our department betweenJune 1980 and December 2005 (Table1). Of those, 250 (14,4%) lost their graftduring the first year after the renal trans-plant. We analyzed the demographics ofthese patients (Group A), comparingthem with the remaining patients(Group B), in terms of causes of graftloss. We also studied the acute rejectionepisodes and renal function, amongother characteristics.Results: There were differences in thecauses of graft loss and associated pa-thologies in the two groups. In a statisti-cal analysis, immediate renal function,donor age and receptor age werethe main factors predictive of graft sur-vival.Conclusion: There are several factorsassociated with an increased risk of graftloss that should be corrected.

PD-09.09Old-to-old renal transplantationprogram: Single center resultsSchlichter A 1, Steiner T 1, Werner W 2,Jorg S 1

1Dept. of Urology, Friedrich-Schiller-Uni-versity, Jena, Germany; 2Dept. of Urol-ogy, Vogtlandklinikum Plauen, Plauen,Germany

Introduction and Objective: More than60% of patients with chronic renal failureon the transplantation waiting lists areolder than 65 years. And approximately50% of these patients have concomitantdiseases, like diabetes, severe hyperten-sion, arteriosclerosis and cardiovasculardiseases. The aims of the old-to-old renaltransplantation program are to shorten thewaiting time, shorten the cold ischemictime and use the so-called marginal or-gans.Methods: The inclusion criteria for thisprogram are: 1. donor and recipient are65 years or older, 2. AB0-compatibilityand, 3. local transplantation with a shortcold ischemic time. We reviewed the re-sults of the patients transplanted at ourcentre regarding patient survival, graftsurvival, graft function and some otherparameters.Results: From January 1999 to January2003 we performed 44 renal transplanta-tions within the old-to-old-program. Themedian age of the donors and the recipi-ents was 69.2 years (range 65-77 years)and 66.4 years (range 55-72 years) re-spectively. The cold ischemic time was9 hours and 57 minutes and the time ofanastomosis was 42 minutes. The me-dian mismatches in A-, B- and DR-locuswere 1.4, 1.7 and 1.4. There were nodeaths postoperatively. The diuresis vol-ume and serum creatinine on the 10thpostoperative day was 2200 ml and 222�mol/l respectively. During the follow-up, six patients (13.6%) died, one pa-tient of metastatic renal cell cancer, twopatients of cardiopulmonary insufficency

Table 1. PD-09.08

Group A Group B PReceptor age 44.6�13.3 40.7�13.8 NSDonor age 37.1�16.0 32.4�14.9 �0.01Hemodyalisis (mo) 43.0�42.1 37.2�34.5 �0.01Immediate graft function 72.3% 83.3% 0.001Acute rejection 30.2% 36.6% NSSurgery (�3 h) 57.7% 68.3% �0.05Renal function: creatinine (mg/dl)

1 month 2.8 1.6 �0.0011 year 6.1 1.4 �0.001

Follow-up (yr) 0.3�0.3 7.5�4.7 �0.001

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UROLOGY 68 (Supplement 5A), November 2006 33

and three of unknown causes. Four pa-tients (9.1%) had a primary graft mal-function and seven patients (15.9%) re-turned to dialysis 3 to 23 months postoperatively because of chronic graft dys-function. In the remaining 27 patients(61.3%), the graft function was sufficientto avoid hemodialysis.Conclusions: Our results are compara-ble with the results of other centers. Bycareful selection of elderly patients withchronic renal failure for transplantation,it is possible to achieve saticfactory re-sults regarding patient survival, graft sur-vival and good quality of life. Personswith severe comorbid conditions shouldbe excluded from renal transplantation.Dialysis is an alternative option for thesepatients.

PD-09.10Experience with 350 cases oflaparoscopic live donor nephrectomy;development of cost-effectivetechniquesKumar A, Gupta N, Srivastava A,Dubey DSGPGIMS, Lucknow, India

Introduction: Laparoscopic instrumenta-tion poses a significant cost burden topatients in developing countries. Wepresent herein the development of cost-effective techniques of laparoscopic livedonor nephrectomy at our institution.Materials and Methods: Between 1999-2005, 350 patients underwent laparo-scopic live donor nephrectomy at our in-stitution. The first 75 patients underwenta lap-assisted procedure (LADN) whererenal mobilization was performed laparo-scopically and hilar clamping and renalextraction were done through a subcostalincision. 136 patients underwent a stan-dard laparoscopic DN where hilar clamp-ing was performed using Hemo-Lok clipsand renal extraction carried out through a5cm flank incision or a Pfannensteil inci-sion. 40 patients (8-right, 23-left) under-went retroperitoneoscopic donor ne-phrectomy (RDN) where renal extractionwas done by flank, Pfannensteil or lumbarincisions.Results: Conversion to open nephrec-tomy was required in 12 (4%) patients.Two patients were re-explored forbowel injury and 2 for haemorrhage.One patient developed post-operativehydro-pneumothorax that required chesttube drainage. Blood transfusion wasrequired in 22 (7.33%) patients. Themean warm ischemia time was 3.2 min-utes (range 2-13 minutes). Costly dispos-

able like extraction devices or GIA sta-plers were not required in any case. Wecan cut down the costs by using all me-tallic autoclavable instruments and he-molock clips.Conclusions: In developing countries,innovative cost saving strategies canbe developed to transfer benefits oflaparoscopic donor nephrectomy to liv-ing donors without imposing a cost bur-den.

PD-09.11Radiocephalic fistula at elbow-Asimple solution to prevent vascularsteal syndrome associated withbrachiocephalic fistula: review of over300 casesKumar A, Gupta N, Srivastava A, DubeyD, Raina P, Vijjan VK, Jha MSGPGIMS, Lucknow, India

Introduction: Brescia-Cimino internalarteriovenous fistula at wrist introducedin 1966 is the vascular access procedureof choice for dialysis, even today. Fail-ure of arteriovenous fistula at wrist ornon-availability of a peripheral vein inthe vicinity of radial artery necessitatesthe creation of brachiocephalic fistula atelbow. The most troublesome complica-tion of brachiocephalic fistula is vascularsteal syndrome. The reported incidenceranges from 1.6 to 20%. Making end toside radiocephalic fistula at elbow caneasily prevent this.Materials and Method: We have per-formed over 300 radiocephalic/ radio-median vein fistula at elbow over past15 years. A 4-5 cm transverse incisionwas given over the brachial artery, 2fingerbreadths below the elbow crease.If median cubital vein is found it is anas-tomosed to the radial artery just distalto the brachial artery bifurcation or elsethe cephalic vein was used at the samelevel. We present our experience inradiocephalic/radio-median fistulaat elbow with particular emphasis onthe management and prevention of thecomplications of vascular access sur-gery.Results: One-year patency rate in our pa-tients was over 90%. None of our patientshad vascular steal phenomenon.Conclusion: Radiocephalic fistula at el-bow is a good alternative to brachioce-phalic fistula with no incidence of vascu-lar steal phenomenon in our experience.Most of the complications of vascular ac-cess surgery are preventable. When thesecomplications occur, the best possible

salvage is in the hands of experiencedvascular surgeons only.

PD-10: AndrologyWednesday, November 1510:15-12:15

PD-10.01Long-term survival of inflatable penileprosthesesWilson SK, Delk Jr. J, Neeb A, Cleves MUniversity of Arkansas, Little Rock, AR,USA

Introduction and Objective: Long-termrevision-free survival greater than 5 yearshas never been reported for inflatable pe-nile prostheses. We conducted a prospec-tive study of almost 6000 implant surger-ies (original implant, revisions, removals)involving 14 different models over the lasttwo decades by the same surgical team.From this data we estimated 10 and 15years-survival of first time (virgin) implan-tations in 2384 patients with 4 differentmodels.Methods: Data was obtained from medi-cal records and patient interviews, en-tered into a computerized database andanalyzed by a third party. Information in-cluded implant type, date, revision historywith date and reason. 14 different in-flatables were examined. Mentor Alpha 1,Mentor Alpha NB, AMS 700 CX and AMS700 Ultrex had usage for an extended pe-riod of time. Because of failure times be-ing confounded due to prior implants,only virgin implants were examined. Revi-sion free survival was estimated using theKaplan-Meier product limit method andcompared using the log rank test.Results: For the entire series estimated10-years revision-free survival for all rea-sons was 68.5% and the 15-years revision-free survival was 59.7%. Freedom frommechanical breakage at 10 years was79.4%; 15-years was 71.2%. Recent me-chanically enhanced models did even bet-ter. In 1992 Mentor Alpha added pumpreinforcement to forestall mechanicalbreakage (J Urol 162:715, 1999). This im-proved 10-years survival from 65.3% to88.6% (p�0.0001). In 1/01 AMS CX addeda Paralyne coating to the cylinders thatincreased 3-years mechanical survival from88.4 to 97.5% (p�0.0032). Thus far, theenhanced CX 3-years revision-free survivalfrom revision for any cause of 87.4% issuperior to the 78.6% revision-free sur-vival for historical non-coated inflatables(p�0.0002) and similar to the enhancedMentor Alpha 1 (86.7%).

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34 UROLOGY 68 (Supplement 5A), November 2006