Purpose-Renal cell carcinoma (RCC) is rare in patients <40 years old and conflicting data regarding presentation and outcome are present in the literature. We reviewed our experience with young RCC patients comparing them to older counterparts.Methods-We identified 1,720 patients 18-79 years old managed with partial or radical nephrectomy for RCC between 1989 and 2005. Patients were grouped according to age and outcome analyses were conducted.Results-Among the 1,720 RCC patients, there were 89 (5%), 672 (39%), and 959 (56%) patients aged <40, 40-59, and 60-79 years old, respectively. There were no significant differences in sex, tumor size, TNM stage, or multifocality by age group. However, patients <40 years old were significantly more likely to present with symptomatic tumors (p=0.028). Additionally, there were significant differences in histology by age (p<0.001); chromophobe histology decreased while papillary histology increased with age. Despite similar tumor sizes in each age group, the percentage of patients treated with partial nephrectomy declined with age; 49% of patients <40 years old were treated with partial nephrectomy compared with 35% and 30% of patients aged 40-59 and 60-79 years old, respectively (p<0.001). With a median follow-up of 2.6 years (range 0-14.5), we did not observe a significant difference in cancer-specific survival according to age (p=0.17).Conclusions-Younger RCC patients are more likely to have symptomatic tumors with chromophobe histology although prognosis appears similar across age groups. Older patients are more likely to be treated with radical nephrectomy and this requires careful scrutiny for current clinical practice.
Background Ureteroscopy combined with laser stone fragmentation and basketing is a common approach for managing renal and ureteral stones. This procedure is associated with some degree of ureteral trauma. Ureteral trauma may lead to swelling, ureteral obstruction, and flank pain and may require subsequent interventions such as hospital admission or secondary ureteral stent placement. To prevent such issues, urologists often place temporary ureteral stents prophylactically, but the value of doing so remains unclear. Objectives To assess the effects of postoperative ureteral stent placement after uncomplicated ureteroscopy. Search methods We performed a comprehensive search using multiple databases (the Cochrane Library, MEDLINE, Embase, Scopus, Google Scholar, and Web of Science), trials registries, other sources of grey literature, and conference proceedings, up to 01 February 2019. We applied no restrictions on publication language or status. Selection criteria We included trials in which researchers randomised participants undergoing uncomplicated ureteroscopy to placement of a ureteral stent versus no ureteral stent. Data collection and analysis Two review authors independently classified studies and abstracted data from the included studies. We performed statistical analyses using a random-effects model. We rated the certainty of evidence (CoE) according to the GRADE approach. 1 Ureteral stent versus no ureteral stent for ureteroscopy in the management of renal and ureteral calculi (Review)
Within the range of times in these series renal ischemia did not have a clinically significant impact on global renal function in patients with 2 functioning kidneys who underwent laparoscopic partial nephrectomy, as measured by the estimated glomerular filtration rate.
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