Objective-We evaluated our experience with renal cortical tumors to determine if tumor size is associated with malignant histology and/or nuclear grade.Materials and Methods-We identified 2,675 patients treated surgically at Memorial SloanKettering for renal cell carcinoma (RCC) or a benign tumor between 1989 and 2007. Histologic subtype and tumor size were obtained from our kidney cancer database and logistic regression analyses were performed.Results-Among the 2,675 tumors, 311 (12%) were benign while 2,364 (88%) were RCC. The odds ratio for association of malignancy with tumor size was 1.16 (95% CI 1.11-1.22; p<0.001), indicating that each 1cm increase in tumor size was associated with a 16% increase in the odds of malignancy. The percentage of benign tumors decreased from 38% for those less than 1 cm to 7% for tumors 7 cm or greater. For patients with clear cell RCC, each 1 cm increase in tumor size increased the odds of a high grade (Fuhrman grade 3-4) compared with a low grade (Fuhrman grade 1-2) tumor by 25% (odds ratio 1.25, 95% CI 1.21-1.30; p<0.001). For this subset, the percentage of high grade tumors increased from 0% for tumors <1cm to 59% for tumors >7cm.Conclusions-Our results confirm previous observations suggesting that the risk of malignancy and risk of high grade tumors increases with tumor size. Patients with small renal masses have a low risk for harboring a high-grade clear cell malignancy which may be useful during initial consultation.

OBJECTIVE To evaluate the difference between radiographic size on computed tomography (CT) and the pathological size of renal tumours, in contemporary patients. PATIENTS AND METHODS We retrospectively reviewed the records of 521 patients undergoing surgical resection of a renal mass between 2000 and 2007, who had tumour sizes recorded from both preoperative CT and pathological evaluation of the tumour specimen. Data on histological tumour type were also extracted. The paired Student’s t‐test was used to compare the mean radiographic size as measured on CT with the mean pathological size, with P < 0.05 considered to indicate statistical significance. RESULTS For all patients, the mean radiographic size and mean pathological size was 4.79 and 4.69 cm, respectively (P = 0.02). Therefore, on average, radiographic size overestimated pathological size by 1 mm. In patients with a tumour of 4–7 cm, radiographic size overestimated pathological size by 0.21 cm (P = 0.007). However, there was no significant difference in patients with a tumour of <4 cm or >7 cm. CONCLUSIONS Using contemporary patients, there was a statistically significant overestimation of renal tumour sizes by CT compared with the pathological assessment. However, the overall difference between radiographic and pathological tumour size was 1 mm, suggesting that CT provides an accurate method with which to estimate renal tumour size.

This retrospective study in a large cohort of patients showed no statistically significant association between statin use and recurrence or progression to open surgery in patients treated with bacillus Calmette-Guerin for transitional cell carcinoma of the bladder. Based on these data patients should not be discouraged from taking statins while undergoing bacillus Calmette-Guerin treatment.

Introduction: The objective was to determine the prevalence of, and factors that predict, detrusor underactivity (DU) in patients presenting with incontinence or lower urinary tract symptoms (LUTS) following radical prostatectomy (RP). We also determined the prevalence of bladder outlet obstruction (BOO) and detrusor overactivity (DO) in this population. Methods: Patients who underwent urodynamics post-RP were identified. Detrusor underactivity was defined as a maximum flow rate (Qmax) of ≤15 mL/s and detrusor pressure (Pdet) Qmax <20 cmH20 or maximum Pdet <20 cmH20 during attempted voiding. Abdominal voiding (AV) was defined as sustained increase in abdominal pressure during voiding. Bladder outlet obstruction and DO were identified using the Abrams-Griffiths nomogram and the International Continence Society criteria. Univariate logistic regression was used to determine factors predicting DU. The following factors were analyzed: age, year of RP, procedure type (minimally-invasive surgery [MIS] or open), postoperative radiation, nerve-sparing, clinical stage, biopsy Gleason grade and interval between RP and evaluation. Results: Between 2005 and 2008, 264 patients underwent urodynamics post-RP. Detrusor underactivity was observed in 108 patients (41%; 95% CI 35%, 47%), of whom 48% demonstrated AV. Overall, BOO and DO were present in 17% (95% CI 12%, 22%) and 27% (95% CI 22%, 33%), respectively. On univariate analysis, only MIS RP was predictive of DU (univariate odds ratio 2.05 for MIS vs. open; p = 0.009). Conclusions: Detrusor underactivity and AV are common in patients presenting for evaluation of incontinence or LUTS following RP. The etiology of DU in this setting is likely related to the surgical approach. Because DU may affect the success of male incontinence treatment with the male sling or artificial urinary sphincter, it is useful to document its presence prior to treatment. More studies are needed to elucidate the influence of DU on treatment success for male urinary incontinence following RP.

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Objectives Focal treatment is a curative option for localized prostate cancer (PCA), but appropriate selection of patients hasn’t been established. We analyzed patients who had undergone radical prostatectomy (RP), with preoperative disease features considered favorable for focal treatment, to test the hypothesis that they would be accurately characterized with transrectal biopsy and prostate MRI. Methods 202 patients with PCA who had preoperative MRI and low-risk biopsy criteria (no Gleason grade 4/5, one involved core, < 2 mm, PSA density ≤ 0.10, clinical stage ≤ T2a). Indolent RP pathology was defined as no Gleason 4/5, organ confined, tumor volume < 0.5cc, negative surgical margins. MRI ability to locate and determine the tumor extent was assessed. Results After RP, 101 men (50%) had non-indolent cancer. Multifocal and bilateral tumors were present in 81% and 68% of patients, respectively. MRI indicated extensive disease in 16 (8%). MRI sensitivity to locate PCA ranged from 2–20%, and specificity from 91–95%. On univariate analysis, MRI evidence of extracapsular extension (ECE) (P = 0.027) and extensive disease (P = 0.001) were associated with non-indolent cancer. On multivariate analysis, only the later remained as significant predictor (P = 0.0018). Conclusions Transrectal biopsy identified men with indolent tumors favorable for focal treatment in 50% of cases. MRI findings of ECE and extensive tumor involving more than half of the gland are associated with unfavorable features, and may be useful excluding patients from focal treatment. According to these data, endorectal MRI isn’t sufficient to localize small tumors for focal treatment.

OBJECTIVE To compare haemostasis and other outcomes after the use of bovine‐derived or porcine‐derived gelatine matrix‐thrombin sealants (GMTS) in a continuous series of patients during and for 6 months after laparoscopic partial nephrectomy (LPN). PATIENTS AND METHODS Between October 2006 and September 2007, a consecutive sample of 35 patients with renal tumours underwent LPN by a single surgeon at a referral centre. Group 1 (25 patients) received a bovine‐derived GMTS and Group 2 (10 patients) a porcine‐derived GMTS. All patients underwent LPN and received one of the two GMTS, applied to the resected bed before sutured renorrhaphy over oxidized nitrocellulose bolsters. Surgical and pathology variables, including ischaemia time, blood loss, tumour size, and serum creatinine values before and after LPN, were measured. Glomerular filtration rates were calculated before and after LPN. Haemostasis was ascertained by visual examination. RESULTS Intraoperative haemostasis was achieved in all cases. No associated complications occurred within 3 weeks of LPN. The two groups were comparable in age (median, 65 vs 69 years, P = 0.62), gender, tumour number and location, median ischaemia time (34 vs 28 min, P = 0.148), and blood loss (200 vs 150 mL, P = 0.518). One patient in Group 1 developed a urinary fistula. One patient in Group 2 experienced self‐limited gross haematuria. CONCLUSIONS Both the porcine‐ and bovine‐derived agents provided acceptable haemostasis without adverse events during LPN and in the early postoperative period. Occurrences of delayed haemorrhage and urinary fistula were not likely to be related to the choice of prothrombotic agent.

RESULTSIn all, 79 men were analysed (mean age 59.8 years, range 38.1-81.5). Nine (11%) patients had PD and had a IPP implanted, with penile modelling. Overall, 43 (54%) patients had pre-existing DM and 51 (65%) actively used tobacco. At a mean (range) follow-up of 19.6 (0.1-115.3) months, six (8%) patients had component malfunctions. Of these, three had DM and four actively smoked. Of the nine patients with PD, three developed component malfunctions, vs three (4%) who did not have PD ( P = 0.002). Both groups had similar infection rates ( P = 0.98). The mean (range) time to component malfunction was 4.3 (0.1-9.6) months, which was longer (but not significantly) in the PD group, with a mean (median, range) of 10.9 (6.3, 1.1-9.6) months, than the 3.0 (1.0, 0.2-7.9) months in the group without PD ( P = 0.4). Groups were matched for rates of DM ( P = 0.1) and tobacco use ( P = 0.2). PD was a significant predictor of component malfunction on both univariate ( P = 0.001) and multivariate analysis ( P = 0.002) when adjusting for age ( P = 0.2), body mass index ( P = 0.7), DM ( P = 0.3) and tobacco use ( P = 0.8). CONCLUSIONPatients with PD implanted with a IPP, with penile modelling, had significantly higher component malfunction rates. Further, PD independently predicted component malfunction. These findings might be related to stress on the device at the time of surgery, during use, or both. Further study into this relationship is required.