Purpose Detection of small renal masses is increasing with the use of cross-sectional imaging, although many incidental lesions have negligible metastatic potential. Among malignant masses, clear cell renal cell carcinoma is the most prevalent and aggressive subtype, and a method to identify such histology would aid in risk stratification. Our goal was to evaluate a likelihood scale for multiparametric magnetic resonance imaging in the diagnosis of clear cell histology. Methods Patients with cT1a masses who underwent MRI and partial or radical nephrectomy from December 2011 to July 2015 were retrospectively reviewed. Seven radiologists with different levels of experience and blinded to final pathology independently reviewed studies based on a predefined algorithm, and applied a clear cell likelihood score: 1) definitely not, 2) probably not, 3) equivocal, 4) probably, and 5) definitely. Binary classification determined the accuracy of clear cell versus ‘all other’ histologies, and inter-observer agreement was calculated with a weighted κ statistic. Results In total, 110 patients with 121 masses were identified. Mean tumor size was 2.4 cm and 50% were clear cell. Defining clear cell as scores ≥4 demonstrated sensitivity and specificity of 78% and 80%, respectively, while scores ≥3 were 95% and 58%, respectively. Inter-observer agreement was moderate to good, with a mean κ of 0.53. Conclusions A clear cell likelihood score with MRI can reasonably identify clear cell histology in small renal masses, and may reduce the number of diagnostic renal mass biopsies. Standardization of imaging protocols and reporting criteria are needed to improve inter-observer reliability.

Purpose To determine the diagnostic performance and inter-reader agreement of a standardized diagnostic algorithm for determining the histologic type of small (<=4cm) renal masses (SRM) with multiparametric magnetic resonance imaging (MRI). Materials and Methods This single-center, retrospective, HIPAA-compliant, IRB-approved study included 103 patients with 109 SRM, resected between December 2011 and July 2015. The requirement for informed consent was waived. Pre-surgical renal MRIs were reviewed by 7 radiologists with diverse experience. Eleven MRI features were assessed and a standardized diagnostic algorithm used to determine the most likely histologic diagnosis, which was compared to histopathology after surgery. Inter-reader variability was tested with Cohen’s κ. Regression models using MRI features were used to predict the histopathologic diagnosis with 5% significance level. Results Clear-cell (ccRCC) and papillary type renal cell carcinomas (pRCC) were diagnosed with respective sensitivities of 85% (47/55) and 80% (20/25), and specificities of 76% (41/54) and 94% (79/84). Inter-reader agreement was moderate-to-substantial (ccRCC, κ=0.58; pRCC, κ=0.73). Signal intensity of the lesion on T2-weighted images (T2W) and degree of contrast enhancement during corticomedullary phase (CE) were independent predictors of ccRCC (T2W OR: 3.19 CI95%: [1.4, 7.1], p=0.003; CE OR: 4.45 [1.8, 10.8], p<0.001) and pRCC (CE OR: 0.053 [0.02, 0.2], p<0.001), both with substantial inter-reader agreement (T2W, κ=0.69; CE, κ=0.71). Lower performance was observed for chromophobe histology, oncocytomas, and minimal-fat angiomyolipomas, [ranges, sensitivity=14%(1/7)–67%(4/6), specificity=97%(100/103)–99%(101/102)], with fair-to-moderate inter-reader agreement (κ=0.23–0.43). Segmental enhancement inversion was an independent predictor of oncocytomas (OR: 16.21 [1.0, 275.4], p=0.049), with moderate inter-reader agreement (κ=0.49). Conclusion The proposed standardized MRI-based diagnostic algorithm had a diagnostic accuracy of 81% (88/109) and 91% (99/109) for the diagnosis of ccRCC and pRCC, respectively, while achieving moderate to substantial inter-reader agreement among 7 radiologists.

Only the UFGSI score could predict the disease severity and the patients' survival. The findings did not support previous findings that an UFGSI threshold of 9 is a predictor of mortality during initial evaluation.

No abstract

Contemporary minimally invasive surgical (MIS) treatment options of patients with male Lower Urinary Tract Symptoms (LUTS) in men with prostate glands >80 mL include Holmium Laser Enucleation Prostate (HoLEP), Thulium laser VapoEnucleation Prostate (ThuVEP), and Laparoscopic (LSP) or Robotic-Assisted Simple Prostatectomy (RASP). Implementing new laser technologies is costly, and the steep learning curve of these laser techniques limit their wide range use. This promoted the use of LSP and RASP in centers with readily established laparoscopy or robotic surgery programs. The aim of this study is to review case and comparative series of RASP. We systematically reviewed published data from 2008 to 2020 on RASP and have identified 26 non-comparative and 9 comparative case series. RASP has longer operation time but less time spent in hospital and less blood loss. The outcomes of improvements in symptom score, post-voiding residual urine (PVR), postoperative PSA decline, complications, and cost are similar when compared to open and laser enucleation techniques. These outcomes position RASP as a viable MIS treatment option for patients with male LUTS needing surgical treatment for enlarged prostates. Nevertheless, prospective, randomized controlled trials (RCTs) with multicenter and large sample size are needed to confirm the findings of this systematic review.

Background Ileus is common after elective colorectal surgery, and is associated with increased adverse events and prolonged hospital stay. The aim was to assess the role of non‐steroidal anti‐inflammatory drugs (NSAIDs) for reducing ileus after surgery. Methods A prospective multicentre cohort study was delivered by an international, student‐ and trainee‐led collaborative group. Adult patients undergoing elective colorectal resection between January and April 2018 were included. The primary outcome was time to gastrointestinal recovery, measured using a composite measure of bowel function and tolerance to oral intake. The impact of NSAIDs was explored using Cox regression analyses, including the results of a centre‐specific survey of compliance to enhanced recovery principles. Secondary safety outcomes included anastomotic leak rate and acute kidney injury. Results A total of 4164 patients were included, with a median age of 68 (i.q.r. 57–75) years (54·9 per cent men). Some 1153 (27·7 per cent) received NSAIDs on postoperative days 1–3, of whom 1061 (92·0 per cent) received non‐selective cyclo‐oxygenase inhibitors. After adjustment for baseline differences, the mean time to gastrointestinal recovery did not differ significantly between patients who received NSAIDs and those who did not (4·6 versus 4·8 days; hazard ratio 1·04, 95 per cent c.i. 0·96 to 1·12; P = 0·360). There were no significant differences in anastomotic leak rate (5·4 versus 4·6 per cent; P = 0·349) or acute kidney injury (14·3 versus 13·8 per cent; P = 0·666) between the groups. Significantly fewer patients receiving NSAIDs required strong opioid analgesia (35·3 versus 56·7 per cent; P < 0·001). Conclusion NSAIDs did not reduce the time for gastrointestinal recovery after colorectal surgery, but they were safe and associated with reduced postoperative opioid requirement.

We evaluated the impact of transrectal prostate needle biopsy (TPNB) on erectile function and on the prostate and bilateral neurovascular bundles using power Doppler ultrasonography imaging of the prostate. The study consisted of 42 patients who had undergone TPNB. Erectile function was evaluated prior to the biopsy, and in the 3rd month after the biopsy using the first five-item version of the International Index of Erectile Function (IIEF-5). Prior to and 3 months after the biopsy, the resistivity index of the prostate parenchyma and both neurovascular bundles was measured. The mean age of the men was 64.2 (47-78) years. Prior to TPNB, 10 (23.8%) patients did not have erectile dysfunction (ED) and 32 (76.2%) patients had ED. The mean IIEF-5 score was 20.8 (range: 2-25) prior to the biopsies, and the mean IIEF-5 score was 17.4 (range: 5-25; p < 0.001) after 3 months. For patients who were previously potent in the pre-biopsy period, the ED rate was 40% (n = 4/10) at the 3rd month evaluation. In these patients, all the resistivity index values were significantly decreased. Our results showed that TPNB may lead to an increased risk of ED. The presence of ED in men after TPNB might have an organic basis.

Objective: We aimed to compare the safety and efficacy of monopolar and bipolar transurethral resection (TUR) of bladder tumors (TURBTs). Material and Methods: A total of 240 patients who underwent TURBT were prospectively included in the study from May 2011 to May 2014. All patients with suspected bladder tumors were eligible for study inclusion. Those who refused consent and those undergoing routine restaging TURBT were excluded from analysis. Patients were divided on the basis of the monopolar arm and the bipolar arm. Study outcomes included the incidence of bladder perforation and obturator jerk, decrease in hemoglobin and sodium levels, rates of re-coagulation and blood transfusion, TUR syndrome, and operation time. Results: The mean age of the patients was 62 ± 13.7 years. The incidence of obturator jerk and bladder perforation was greater in the bipolar arm. However, with a decrease in the hemoglobin and sodium levels, rates of re-coagulation and blood transfusion were greater in the monopolar arm. Statistical analysis did not show significant differences with regard to study outcomes between the groups. There was no case of TUR syndrome in the 2 arms. The residual tumors' rate was similar between the 2 groups. Conclusions: Our results showed that efficacy and safety of the monopolar and bipolar methods seems to be comparable in patients with bladder tumors.