e450 THE JOURNAL OF UROLOGY� Vol. 191, No. 4S, Supplement, Sunday, May 18, 2014

adapters were enriched by 4 cycles of PCR. The samples werethen sequenced using Ion Torrent Personalized Genome Machineand 400 bp chemistry. Sequences were then analyzed using QIIMEpipeline, allowing us to identify and quantify which specieswere present.

RESULTS: DNA extraction, amplification and sequencingwere successful in 6/9 patients. Analysis showed lactobacilli to be themost frequent organisms in the vulvar specimens. While the perinealspecimens also showed lactobacilli as a common organism, Por-phyromonas somerae was also frequently identified. This species,formerly classified within Bacteroides, is a potential pathogen. This isa novel finding.

CONCLUSIONS: We have demonstrated the ability to non-invasively sample and characterize the perineal and vulvar microflora inprepubertal girls. This lays the ground for future studies which will focuson alterations in the microflora associated with urinary tract infectionsand antibiotic treatment.

Source of Funding: The Society for Pediatric Urology

MP44-20PERSISTENT VESICOURETERAL REFLUX AFTER ILEOCECALCYSTOPLASTY IN CHILDREN WITH VOIDING DYSFUNCTION

Ahmed Shahat*, Mohammed Elgammal, Alaa Abdelmoeim,Hisham Hammouda, Assiut, Egypt

INTRODUCTION AND OBJECTIVES: To define incidence, riskfactors and effect of persistent vesivoureteral reflux [VUR] after ileo-cecal cystoplasty in children with voiding dysfunction.

METHODS: Between June 2008 and June 2013, children 5-18 years old, who had VUR before ileocecal cystoplasty withoutureteral reimplantation, were included. Voiding cystourethrogramand pressure flow studies were obtained before and 6-12 monthsafter the operation. VUR was graded using the international refluxstudy committee classification. Grades I, II, and III were consideredlow grade. Grades IV and V were considered high grade. VURpersistence was analyzed in relation to age, sex, cause of voidingdysfunction, laterality, preoperative and postoperative maximumdetrusor filling pressure, and preoperative grade of reflux. Attacks offebrile acute pyelonephritis were recorded and analyzed in relationto VUR persistence. Follow up period ranged from 12 to 55 months[mean 34.1].

RESULTS: 25 refluxing renal units in 13 children [8 males and 5females] were included. Age range was 6-16 years [mean 11.06]. Thecause of voiding dysfunction was neurogenic in 8, dysfunctional voidingin 3, and valve baldder in 2. All of them had ileocecal cystoplasty withenforced in-situ appendicular catheterizable stoma. VUR was low gradein 4 renal units and high grade in 21. Postoperative low grade VUR wasfound in 13 renal units (52%), and no high grade VUR. Preoperativehigh grade reflux was significantly related to VUR persistence (Chi-square, p¼0.023). Mean preoperative maximum detrusor filling pres-sure with persistent reflux was 61.1 �5.8 cmH2O, and 72.1 �10.3cmH2O with cured reflux (t-test, p¼0.003). 8 renal units in 6 patients hadattacks of acute pyelonephritis. Persistent VUR was in 6 of them (Chi-square, p¼0.007).

CONCLUSIONS: Preoperative high grade VUR and lowmaximum detrusor filling pressure are risk factors for persistent VURafter ileocecal cystoplasty in children. Persistent VUR is a risk factor foracute pyelonephritis and may have a deleterious effect on the kidney.

Source of Funding: none

Prostate Cancer: Basic Research III

Moderated Poster

Sunday, May 18, 2014 3:30 PM-5:30 PM

MP41-01HIGHER GRADE PROSTATE CANCER STRATIFICATION BY ERGONCOPROTEIN AND SPINK1 EXPRESSION IN CAUCASIANAMERICAN AND AFRICAN AMERICAN MEN

James Farrell*, Denise Young, Michael Degon, Rockville, MD;Sudhir Srivastava, Bethesda, MD; Jacob Kagan, Jennifer Cullen,Gyprgy Petrovics, Inger Rosner, David G. McLeod,Isabell A. Sesterhenn, Shiv Srivastava, Rockville, MD

INTRODUCTION AND OBJECTIVES: Observed differences inincidence and disease aggressiveness of prostate cancer (CaP) atpresentation suggest different pathways of carcinogenesis betweenAfrican American (AA) and Caucasian American (CA) men. ERG is themost common oncogene expressed in CaP. Prior studies suggestedthat ERG is more common in CaP of CA than in AA men. Recentstudies also suggest that SPINK1, the gene that encodes tumor-asso-ciated trypsin inhibitor, is common in ERG negative cancers. As thedifference in ERG frequency appeared to be most pronounced betweenAA and CA patients with higher grade tumors, we sought to describe theexpression of ERG and SPINK1 in the proteome of higher gradeprostate cancer stratified by race.

METHODS: Materials and Methods: The Center for ProstateDisease Research database was queried to identify patients with highergrade disease who underwent radical prostatectomy, and clinical datafrom 1304 patients were evaluated. Selected patients had a Gleasonscore of 8-10, or primary pattern 4 or 5 disease. A total of 63 AA menmet study criteria and 63 CA men were matched against them. Immu-nohistochemistry was performed to detect ERG and SPINK1 oncopro-tein in representative whole mount prostate specimens

RESULTS: The frequency of ERG positive index tumors inhigher grade disease was significantly greater among CA mencompared to AA men (49% vs.16%, P < .0001), whereas SPINK1 wasmore common among AA men (65% vs. 49%, P ¼ 0.07). In all casesSPINK1 expression was focal. In 18 of 63 CA and 7 of 63 AA men ERGand SPINK1 were co-expressed in the same tumor. ERG and SPINK1positivity were not predictive of biochemical recurrence, but SPINK1was identified in 2 of 7 patients with lymph node metastases.

CONCLUSIONS: Overall, ERG and SPINK1 expression variedacross ethnicity in this higher grade cohort, and SPINK1 was present ina much greater proportion of patients than previously reported. Ourstudy underscores, that molecular typing of CaP in the context ofethnicity may enhance our understanding of phenotypic variationsand outcomes

Source of Funding: Source of Funding: National CancerInstitute grant to S.S., grant number: R01CA162383 and by theEDRN/NCI ACN12011-001-0 to GP, AD, IAS, DGM and SS.

MP41-02CLINICAL AND PATHOLOGIC CHARACTERIZATION OF ERGEXPRESSION AND TESTOSTERONE IN AFRICAN AMERICANS

Michael Degon*, Denise Young, Yongmei Chen, Gyorgy Petrovics,Jennifer Cullen, Rockville, MD; Jacob Kagan, Sudhir Srivastava,David McLeod, Bethesda, MD; Albert Dobi, Rockville, MD;Isabell Sesterhenn, Silver Spring, MD; Shiv Srivastava, Rockville, MD

INTRODUCTION AND OBJECTIVES: African-American menare more likely to be diagnosed with prostate cancer and more likely todie from prostate cancer then Caucasian Americans prompting intense