Vascular clamping during open nephron sparing surgery is associated with a higher incidence of renal complications. Attempts to limit warm ischemia to 20 minutes and cold ischemia to 35 minutes should be used when vascular clamping is necessary.

Open surgical partial nephrectomy can be safely performed in patients with tumor in a solitary kidney. Long-term cancer-free survival with the preservation of renal function can be reliably expected in most of these cases.

ObjectivesTo compare outcomes of renal transplantation (RTx) in children with end-stage renal disease (ESRD) resulting from lower urinary tract dysfunction (LUTD) vs other causes. Patients and MethodsA database of children (<18 years old) who underwent RTx between May 2008 and April 2012 was reviewed. Patients were divided into those with LUTD (group A, n = 29) and those with other causes of ESRD (group B, n = 74). RTx was performed after achieving low intravesical pressure (<30 cmH 2 O) with adequate bladder capacity and drainage. The groups were compared using Student's t-test, MannWhitney, chi-squared or exact tests. Graft survival rates (GSRs) were evaluated using Kaplan-Meier curves and the log-rank test. ResultsThe mean AE SD (range) age of the study cohort was 5.05 AE 12.4 (2.2-18) years. Causes of LUTD were posterior urethral valve (PUV; 41.4%), vesico-ureteric reflux (VUR; 37.9%), neurogenic bladder (10.3%), prune belly syndrome (3.4%), obstructive megaureter (3.4%) and urethral stricture disease (3.4%). There was no significant difference in age, dialysis duration or donor type. In group A, 25 of the 29 patients (86.2%) underwent ≥1 surgery to optimize the urinary tract for allograft. Pretransplant nephrectomy was performed in 15 of the 29 patients (51.7%), PUV ablation in nine patients (31%) and ileocystoplasty in four patients (13.7%). The mean AE SD follow-up was 4.52 AE 1.55 and 4.07 AE 1.27 years in groups A and B, respectively. There was no significant difference in creatinine and eGFR between the groups at different points of follow-up. The GSRs at the end of the study were 93.1 and 91.1% in groups A and B, respectively (P = 1.00). According to Kaplan-Meier survival curves, there was no significant difference in the GSR between the groups using the log-rank test (P = 0.503). No graft was lost as a result of urological complications. In group B, one child died from septicaemia. The rate of urinary tract infections was 24 and 12% in groups A and B, respectively, but was not significant. No significant difference was found between the groups with regard to the incidence of post-transplantation hydronephrosis. Of the 22 patients who had hydronephrosis after transplantation, three were complicated by UTI. Injection of bulking agents was required in two patients for treatment of grade 3 VUR. In the third patient, augmentation cystoplasty was needed. ConclusionAcceptable graft function, survival and UTI rates can be achieved in children with ESRD attributable to LUTD. Thorough assessment and optimization of LUT, together with close follow-up, are key for successful RTx.

Purpose-Recent data demonstrate that age may be a significant independent prognostic variable following treatment for renal cell carcinoma. We analyzed data from the SEER (Surveillance, Epidemiology and End Results) database to evaluate the relative survival of patients treated surgically for localized renal cell carcinoma as related to tumor size and patient age.Materials and Methods-Patients in the SEER database with localized renal cell carcinoma were stratified into cohorts by age and tumor size. Three and 5-year relative survival, the ratio of observed survival in the cancer population to the expected survival of an age, sex and race matched cancerfree population, was calculated with SEER-Stat. Brown's method was used for hypothesis testing.Results-A total of 8,578 patients with surgically treated, localized renal cell carcinoma were identified. While 3 and 5-year survival for patients with small (less than 4 cm) renal cell carcinoma was no different from that of matched cancer-free controls, patients treated for large (greater than 7 cm) localized renal cell carcinoma experienced decreased 5-year relative survival across all age groups. Therefore, age was not a significant predictor of relative survival for patients with small (less than 4 cm) or large (greater than 7 cm) tumors. However, a statistically significant trend toward lower relative survival with increasing age was demonstrated in patients with medium size tumors (4 to 7 cm). Hypothesis testing confirmed these findings.Conclusions-These data suggest that relative survival is high in patients with tumors less than 4 cm and lower in patients with tumors larger than 7 cm regardless of age. However, increasing age may be related to worse outcomes in patients with tumors 4 to 7 cm. The cause of this observation warrants further investigation. Keywords kidney neoplasms; mortalityLike most malignancies RCC is a heterogeneous disease and its clinical course ranges from indolent to highly aggressive. Accurate risk stratification at diagnosis is imperative to determine individualized followup strategies and to identify appropriate candidates for adjuvant therapy trials. Although the TNM staging system developed by the International Union Against Cancer has been shown to stratify cancer related outcomes effectively, several * Correspondence: Department of Urologic Oncology, Fox Chase Cancer Center, 333 Cottman Ave., Philadelphia, Pennsylvania 19111 (telephone: 215-728-3501; FAX: 215-214-1734 This study uses patient data from the SEER cancer database to examine the relationship between age and outcome in a large cohort of patients with surgically treated localized RCC.To avoid the limitations of cause of death reporting we evaluated survival in terms of relative survival-the ratio of observed survival in the cancer population to expected survival in an age, sex and race matched cancer-free population. Materials and MethodsWe used data from the SEER 13 Public Use Registry to create a cohort of patients with kidney cancer diagnosed between 1988 and 1...

Study Type – Therapy (case series)
Level of Evidence 4 What’s known on the subject? and What does the study add? Systemic chemotherapy for muscle‐invasive bladder cancer is underutilized. Currently, debate centers on whether patients should be given neoadjuvant chemotherapy or be given chemotherapy after surgery, depending on the pathology of the specimen. In this paper, we found that greater than 73% of patients had evidence of bladder cancer that was locally advanced, a criteria that would designate these patients for adjuvant chemotherapy. Using this evidence and the knowledge that neoadjuvant chemotherapy confers a survival advantage, we argue that neoadjuvant chemotherapy should be the standard of care. OBJECTIVE To evaluate the clinicopathological outcomes for patients with clinical T2 (cT2) urothelial carcinoma treated with radical cystectomy (RC) without neoadjuvant chemotherapy (NC). PATIENTS AND METHODS We identified 212 patients with cT2 tumours who underwent RC at our institution without NC. Pathological assessment of RC specimens was correlated with clinical stage. The impact of various clinicopathological factors on the outcome of patients with cT2 disease was analysed. RESULTS In total, 153/212 (73.2%) patients with cT2 bladder cancer had either pT3/T4 or pN+ tumours at RC. Moreover, only 58/153 (37.9%) of these patients received adjuvant chemotherapy. The median follow‐up was 28 (months 0.6–107.5) (range). The 5‐year recurrence‐free survival and cancer‐specific survival (CSS) was 56.5% and 59.5%, respectively. On multivariate analysis, increasing age (hazard ratio [HR] 1.04; P= 0.04), advanced pathological stage (HR 1.83; P= 0.02), and positive lymph nodes (HR 3.72; P= 0.001) were adversely associated with CSS, while receipt of adjuvant chemotherapy was protective of disease‐specific mortality (HR 0.45; P= 0.04). CONCLUSIONS Pathological upstaging is prevalent and survival remains modest in patients with cT2 tumours treated with RC without NC. Unfortunately, only 40% of patients that had locally advanced and/or regionally metastatic disease received adjuvant treatment. These data further support the value of NC for patients with muscle‐invasive bladder cancer, even in those with apparent clinically organ‐confined tumours.

No abstract

Laparoscopic diverticulectomy is technically feasible and safe and may represent an alternative to the standard open procedure.

Background It was difficult to compare the outcome of partial nephrectomy among different studies due to the absence of standardized description of different renal masses. This problem led to the development of nephrometry scoring systems. R.E.N.A.L. is among the commonest nephrometry scoring systems; however, some studies failed to find any relation between R.E.N.A.L. with perioperative outcome. We evaluated our designed newly modified nephrometry score in prediction of outcome following partial nephrectomy and compared its predictability versus original R.E.N.A.L. Methods Fifty-one patients with cT1-2N0M0 renal masses amenable for partial nephrectomy were included prospectively. Different perioperative outcome variables were compared according to complexity level in R.E.N.A.L. and the newly modified nephrometry score. Results Clinical staging was T1a (21.6%), T1b (49%), T2a (25.5%), T2b (3.9%). Median R.E.N.A.L. was 9 (4–12). Hilar position and intrarenal pelvis were detected in 19.6% and 68.6%. Low, moderate and high complexity masses were found in 21.6%, 39.2% and 39.2%. Complications and rate of conversion to radical nephrectomy were 17 (33.3%) and 4 (7.8%). The only significantly affected variable (p = 0.039) by R.E.N.A.L. was rate of secondary intervention, but it was higher in low than in high complexity level. In the newly modified nephrometry score, complications (p = 0.037) and rate of positive surgical margin (p = 0.049) were significantly higher with increased complexity level. Although other variables (pelvi-calyceal system entry, operative time, blood loss, hemoglobin loss, blood transfusion and conversion to radical nephrectomy) did not show statistically significant difference according to both scores, they were better associated with the complexity level in the newly modified nephrometry score with their remarkable increase in the high when compared to the low complexity level. Conclusions The newly modified nephrometry score was associated with better prediction of outcome of partial nephrectomy when compared to R.E.N.A.L.