Objective To further evaluate the sensitivity and specificity of urine aquaporin-1 (AQP1) and perilipin-2 (PLIN2) concentrations to diagnose clear cell or papillary renal cell carcinoma (RCC) we compared these unique urine biomarker concentrations in patients with RCC, non-cancer renal masses, bladder cancer and prostate cancer. Patients and Methods From February 1 through October 31, 2012 pre-operative urine samples were obtained from patients with a presumptive diagnosis of RCC based on an imaged renal mass, prostate cancer or transitional cell bladder cancer. Imaged renal masses were diagnosed post-nephrectomy, as cancer or benign, by histology. Urine AQP1 and PLIN2 concentrations were measured by sensitive and specific Western blot and normalized to urine creatinine concentration. Results Median urine AQP1 and PLIN2 in patients with clear cell and papillary RCC (n=47) were 29 and 36 relative absorbance units/mg urine creatinine. In contrast, median concentrations in bladder (n=22) and prostate cancer (n=27), patients with chromophobe tumors (n=7), and in benign renal oncocytoma (n=9) and angiomyolipomas (n=7), were all less than 10 (P <.001 vs RCC for both biomarkers, Kruskal-Wallis test) and comparable to healthy controls. The area under the receiver operating characteristic curve was 0.99 to 1.00 for both biomarkers. Conclusions These results further demonstrate the specificity and sensitivity of urine AQP1 and PLIN2 concentrations for RCC. These novel tumor-specific proteins have high clinical validity and substantial potential as specific screening biomarkers for clear cell and papillary RCC, and in the differential diagnosis of imaged renal masses.

OBJECTIVE To evaluate trends in urine aquaporin-1 (AQP1) and perilipin 2 (PLIN2) concentrations in patients with clear cell and papillary renal cell carcinoma (RCC) this investigation determined the relationship between the urine concentration of these biomarkers and tumor size, grade and stage. MATERIALS and METHODS Biomarker concentrations were determined by sensitive and specific Western blot procedures normalized to urine creatinine excretion. Analysis included 61 patients undergoing a partial or a radical nephrectomy for clear cell or papillary renal cancer and 43 age- and sex-matched control patients. Relationships between urine biomarker concentrations and tumor size, stage, and grade were assessed. RESULTS Patients with renal cell carcinoma had 35-fold and 9-fold higher median urinary AQP1 and PLIN2 concentrations, respectively, compared to controls (p values). Both tumor markers decreased following tumor resection, to concentrations equivalent to those of controls. The sensitivity and specificity were both 100% for AQP1, and 92% and 100% for PLIN2. There was a significant linear correlation between tumor size and prenephrectomy AQP1 (Spearman coefficient 0.78, P<0.001) and PLIN2 (Spearman coefficient 0.69, P<0.001) concentrations. There was a correlation of both markers with tumor stage (overall P=0.030), when stage was dependent primarily on tumor size (stages T1 and T2), but not with stage T3 which reflected extra-renal spread. Neither marker showed a significant correlation with tumor grade. CONCLUSIONS AQP1 and PLIN2 are significantly increased in patients with clear cell and papillary renal cell carcinoma compared to controls. Preoperative urinary concentrations of these markers reflect tumor size and stage.

Robotic surgeries of long duration are associated with both increased risks to patients as well as distinct challenges for care providers. We propose a surgical checklist, to be completed during a second “time-out”, aimed at reducing peri-operative complications and addressing obstacles presented by lengthy robotic surgeries. A review of the literature was performed to identify the most common complications of robotic surgeries with extended operative times. A surgical checklist was developed with the goal of addressing these issues and maximizing patient safety. Extended operative times during robotic surgery increase patient risk for position-related complications and other adverse events. These cases also raise concerns for surgical, anesthesia, and nursing staff which are less common in shorter, non-robotic operations. Key elements of the checklist were designed to coordinate operative staff in verifying patient safety while addressing the unique concerns within each specialty. As robotic surgery is increasingly utilized, operations with long surgical times may become more common due to increased case complexity and surgeons overcoming the learning curve. A standardized surgical checklist, conducted three to four hours after the start of surgery, may enhance perioperative patient safety and quality of care.

Port site metastasis after minimally invasive surgery for renal cell carcinoma is a rare occurrence with a poor prognosis. In most cases port site metastasis is not an isolated metastasis but instead is a harbinger of progressive disease. While technical factors can have a role in port site metastasis formation, it appears that biological factors like high tumor grade also contribute.

"Computed tomography and magnetic resonance findings of fat-poor angiomyolipomas." Journal of Endourology.31,2. 119-128. (2017 Results: A total of 26 fp-AMLs were identified. Thirteen lesions had available unenhanced CT images, of which eight (62%) were hyperdense compared to the adjacent renal parenchyma, while five (38%) were isodense. Twenty lesions had enhanced CT images: 14 (70%) and 6 (30%) with homogeneous and heterogeneous enhancement, respectively. Of the nine lesions with enhanced MR sequences, five (56%) were homogeneously enhancing, and four (44%) were heterogeneously enhancing. Eight of nine (89%) lesions had hypointense signal intensity (SI) on T2-weighted MR sequences, while one (11%) had hyperintense SI. None of the eight lesions displayed a decrease in signal on fat-suppressed sequences. Conclusions: In this study, we confirmed common imaging features of fp-AML: high attenuation on unenhanced CT sequences, homogeneous enhancement on CT, and hypointensity on T2-weighted MR. When these features are present, a renal mass biopsy may be prudent.

Objective To evaluate the role of urine aquaporin 1 and perilipin 2 as biomarkers adjunct to renal mass biopsy in guiding the management of patients with small renal masses. Methods Preoperative aquaporin 1 and perilipin 2 levels in 57 patients with small renal masses undergoing partial nephrectomy were analyzed and compared with postoperative tumor histology. An algorithm was created utilizing aquaporin 1 and perilipin 2 in conjunction with renal mass biopsy. Cut‐off values were implemented to maximize biomarker sensitivity and specificity. Renal mass biopsy utilization and intervention were then compared with rates in traditional renal mass biopsy algorithms. Results All clear cell and papillary renal cell carcinomas were correctly identified and assigned to the treatment path. All benign lesions were correctly sorted to a confirmatory renal mass biopsy path. Two chromophobe masses did not have elevated aquaporin 1 and perilipin 2, and would require renal mass biopsy. Compared with protocols that call for all small renal masses to be biopsied, confirmatory renal mass biopsy could have been safely avoided in 74% of patients with elevated aquaporin 1 and perilipin 2. Compared with protocols that do not utilize renal mass biopsy, surgical intervention would have been avoided in 23% of patients with benign masses. Conclusions Aquaporin 1 and perilipin 2 possess high sensitivity and specificity for detecting clear cell and papillary renal cell carcinoma. Use of these markers might compliment renal mass biopsy in the characterization of small renal masses.

We present a case of persistent pneumaturia of one-year duration in a fifty-five-year-old male with a history of spinal cord injury. The evaluation demonstrated gas throughout the collecting system attributable to a urinary tract infection with a gas-forming organism, Klebsiella pneumoniae.

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