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Objective: The RENAL nephrometry scoring system characterizes tumors according to their size, growth pattern, location and nearness to the renal sinus or collecting system. The current study aims to evaluate the RENAL nephrometry scoring system in adopting nephron-sparing surgery (NSS) for cT1 renal cancer. Methods: Clinicopathological data of 200 consecutive patients who had undergone radical nephrectomy (RN) or NSS for clinical stage T1 renal cell cancer at our single institution during 2005-2009 were investigated retrospectively. Results: Of 200 patients, 103 were scheduled for RN, whereas 97 were planned to undergo NSS, 9 of whom actually underwent RN. Those who were planned to undergo NSS were younger and had smaller tumors (p < 0.001). The median RENAL score was significantly lower among those who were originally assigned to NSS (5, range 4-10) versus RN (8, range 4-11) (p < 0.001). Three months after surgery, the renal function of patients who had been scheduled for NSS was significantly better than in those treated by RN (p < 0.001). Conclusions: This study suggests that the RENAL nephrometry scoring system is a useful tool in adopting NSS for cT1 renal cancer and that objective decision-making for NSS was possible.

BackgroundSunitinib interacts with radiation therapy, leading to synergism of the toxicities of these treatments. Radiation recall pneumonitis is a rare but serious complication of targeted therapy with tyrosine kinase inhibitors.Case presentationThe case of a patient with metastatic renal cell cancer (RCC) who developed recall pneumonitis on the first cycle of systemic sunitinib treatment is reported here. A 65-year-old man with RCC and bone metastasis underwent radiation therapy on his thoracic vertebrae (Th5-8) with a total dose of 24 Gy. Sunitinib (37.5 mg) was started 14 days after completing the radiation therapy. On the 14th day of sunitinib treatment, the patient developed progressive fever with worsening of dyspnea and general weakness. Treatment with pulse administration of prednisolone 1,000 mg for 3 days was initiated. Thereafter, the symptoms and the radiological findings regarding the interstitial filtration gradually improved over 7 days.ConclusionTo our knowledge, this is the first report of early onset recall pneumonitis during sunitinib therapy. At present, how sunitinib interacts with radiation therapy remains unclear. The possibility that tyrosine kinase inhibitor therapy, including with sunitinib, after radiation therapy may lead to adverse effects should be kept in mind.

Objective: To investigate the value of the ultrasonographically determined size of seminiferous tubules and other conventional parameters for predicting sperm retrieval by microdissection testicular sperm extraction (micro-TESE). Design: Clinical retrospective study. Setting: Two urological clinics. Patient(s): Eight hundred six men with nonobstructive azoospermia. Intervention(s): Micro-TESE. Main Outcome Measure(s): Sperm retrieval. Result(s): Sperm retrieval was successful in 240 ( 29.8%) of the 806 men. In a receiver operating characteristic analysis of sperm retrieval, the area under the curve (AUC) for seminiferous tubules, assessed as 0, 100, 200, 250, or 300 mm, was no less than 0.82 (95% confidence interval [CI] 0.79-0.85). Sensitivity and specificity at a cutoff point of 250 mm were 76.7% and 80.7%, respectively. An AUC of 0.85 (95% CI, 0.81-0.88) was attained in a parsimonious multiple logistic regression model that included age (<30, 30-39, and 40-59 years), low follicle-stimulating hormone (<14 IU/L), history of cryptorchidism, and sex chromosome abnormality in addition to the diameter of seminiferous tubules. Conclusion(s):The gray-scale image in testicular ultrasound was shown to be highly predictive of sperm retrieval in micro-TESE in a large series of men with nonobstructive azoospermia.

Objective: It was the aim of this study to assess the outcome of prostate cancer patients with preoperative prostate-specific antigen (PSA) levels ≧100 ng/ml who were treated with antegrade radical prostatectomy with intended wide resection (aRP). Patients and Methods: Eighteen patients who underwent aRP had an initial PSA level ≧100 ng/ml. Overall survival, disease-specific survival and biochemical progression-free survival (bPFS) rates were determined, and predictors of treatment outcome were examined. Results: The median serum PSA level was 159.5 ng/ml. All patients but one had received neoadjuvant androgen deprivation therapy (ADT), while only 2 patients received adjuvant ADT. Five patients were classified as stage pT2, 6 as pT3a, 6 as pT3b and 1 as pT4. Four patients had locoregional lymph node metastases. Twelve patients developed PSA failure. Eight of them received salvage ADT. The estimated 10-year bPFS rate was 25.0% and the overall survival and disease-specific survival rates were 92.9 and 100%, respectively, at a median follow-up of 6 years. Multivariate analysis revealed only the clinical stage to be predictive of bPFS based on preoperative variables. On the other hand, surgical margin status, extracapsular extension and organ-confined disease were identified as being significant postoperative predictors. Conclusions: This study showed a comparatively satisfactory outcome for clinically non-metastatic prostate cancer with PSA levels ≧100 ng/ml treated by aRP.