ObjectivesTo describe the frequency and nature of symptoms in patients presenting with suspected renal cell carcinoma (RCC) and examine their reliability in achieving early diagnosis.DesignMulticentre prospective observational cohort study.Setting and participantsEleven UK centres recruiting patients presenting with suspected newly diagnosed RCC. Symptoms reported by patients were recorded and reviewed. Comprehensive clinico-pathological and outcome data were also collected.OutcomesType and frequency of reported symptoms, incidental diagnosis rate, metastasis-free survival and cancer-specific survival.ResultsOf 706 patients recruited between 2011 and 2014, 608 patients with a confirmed RCC formed the primary study population. The majority (60%) of patients were diagnosed incidentally. 87% of patients with stage Ia and 36% with stage III or IV disease presented incidentally. Visible haematuria was reported in 23% of patients and was commonly associated with advanced disease (49% had stage III or IV disease). Symptomatic presentation was associated with poorer outcomes, likely reflecting the presence of higher stage disease. Symptom patterns among the 54 patients subsequently found to have a benign renal mass were similar to those with a confirmed RCC.ConclusionsRaising public awareness of RCC-related symptoms as a strategy to improve early detection rates is limited by the fact that related symptoms are relatively uncommon and often associated with advanced disease. Greater attention must be paid to the feasibility of screening strategies and the identification of circulating diagnostic biomarkers.

Objective To compare long-term outcomes and peri-operative outcomes of image-guided ablation (IGA) and laparoscopic partial nephrectomy (LPN). Material and methods This is a retrospective cohort study of localised RCC (T1a/bN0M0) patients undergoing cryoablation (CRYO), radio-frequency ablation (RFA), or LPN at our institution from 2003 to 2016. Oncological outcomes were compared using Cox regression and log-rank analysis. eGFR changes were compared using Kruskal-Wallis and Wilcoxon-rank tests. Results A total of 296 (238 T1a, 58 T1b) consecutive patients were identified; 103, 100, and 93 patients underwent CRYO, RFA, and LPN, respectively. Median follow-up time was 75, 98, and 71 months, respectively. On univariate analysis, all oncological outcomes were comparable amongst CRYO, RFA, and LPN (p > 0.05). On multivariate analysis, T1a patients undergoing RFA had improved local recurrence-free survival (LRFS) (HR 0.002, 95% CI 0.00–0.11, p = 0.003) and metastasis-free survival (HR 0.002, 95% CI 0.00–0.52, p = 0.029) compared to LPN. In T1a and T1b patients combined, both CRYO (HR 0.07, 95% CI 0.01–0.73, p = 0.026) and RFA (HR 0.04, 95% CI 0.03–0.48, p = 0.011) had improved LRFS rates. Patients undergoing CRYO and RFA had a significantly smaller median decrease in eGFR post-operatively compared to LPN (T1a: p < 0.001; T1b: p = 0.047). Limitations include retrospective design and limited statistical power. Conclusions IGA is potentially as good as LPN in oncological durability. IGA preserves kidney function significantly better than LPN. More studies with larger sample size should be performed to establish IGA as a first-line treatment alongside LPN. Key Points • Ablative therapies are alternatives to partial nephrectomy for managing small renal cell carcinomas. • This study reports long-term outcomes of image-guided ablation versus partial nephrectomy. • Ablative therapies have comparable oncological durability and better renal function preservation compared to partial nephrectomy.

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The contribution by the units in York and Leeds to tissue‐engineering research is considerable, and they describe here their work to assess a natural matrix for use in the urinary tract, and to develop an in vitro regimen for assessing the biocompatibility of potential biomaterials. They describe how they have developed a simple, reproducible and rigorous regimen which will help to identify the causes of potential bio‐incompatibility. Buccal mucosa has become the tissue of choice for urethroplasty. Authors from Edinburgh report on the oral complications after its harvesting; they found that most patients were satisfied with its use, but that it had long‐term complications, about which patients should be informed. OBJECTIVES To assess the potential of PermacolTM (Tissue Science Laboratories, Swillington, UK), a natural matrix derived from decellularized porcine dermis, as a matrix for urological tissue engineering, and thus to develop an in vitro regimen for assessing the biocompatibility of potential biomaterials before experimentation in animal models. MATERIALS AND METHODS Urinary tract‐derived normal human urothelial (NHU) and smooth muscle (SM) cells were grown in monoculture as autologous cell lines. Permacol was assessed for its ability to support colonization by NHU and SM cells. The failure of the Permacol matrix to be infiltrated by SM cells was further investigated using the highly invasive EJ bladder cancer cell line. RESULTS NHU cells readily attached and grew as a monolayer on the surface of Permacol. Cells stratified when the culture medium was supplemented with 2 mmol/L calcium. EJ cells initially grew on the surface and subsequently invaded the matrix, while SM cells only colonized the surface of Permacol when cocultured with NHU cells. Cytoxicity, evaluated by contact inhibition and conditioned‐medium assays, excluded the presence of soluble toxins in the biomaterial. CONCLUSIONS We developed a simple, reproducible and rigorous regimen for assessing potential biomaterials in vitro. Applying this system might reduce the use of animals and help to identify causes of potential bio‐incompatibility. The inability of SM cells to penetrate the Permacol matrix suggests that required matrix‐bound signalling factors are absent, possibly as a result of the procedures used for processing Permacol. Identifying the key regulatory factors that regulate SM cell growth and orchestrate regenerative processes in the urinary tract will be important for developing suitable biomaterials for the bladder.