The treatment of renal cell carcinoma has evolved tremendously over the years. Initially the entire kidney was removed along with the renal tumor despite the size or extent of the mass. Early attempts to remove tumors with a normal surrounding parenchymal margin showed equivalent oncologic results in small renal masses. Attempts to preserve more renal parenchyma in patients with compromised renal function led to the enucleation of renal masses by blunt dissection following the natural plane between the peritumor pseudocapsule and the renal parenchyma. Enucleation of renal tumors has been especially useful for renal preservation in patients with preoperative renal insufficiency, solitary kidneys, multiple renal lesions and hereditary renal cell carcinoma syndromes. Comparable long-term progression and cancer-specific survival has been shown with tumor enucleation and standard partial nephrectomy. However, there has been considerable controversy regarding the safety of renal tumor enucleation due to histopathologic findings of pseudocapsule tumor invasion. Current data suggest that tumor enucleation is a safe alternative for small renal masses that are locally confined on preoperative imaging, easily delineated intraoperatively and do not appear to grossly invade beyond the pseudocapsule.
There has been a greater acceptance of tumor enucleation as a safe alternative for renal masses which are locally confined on preoperative imaging, easily delineated intraoperatively, and do not appear to grossly invade beyond the pseudocapsule.
Abbreviations and AcronymsCT, computed tomography FISH, fluorescence in situ hybridization ABSTRACT Exercise-induced hematuria is an uncommon clinical entity experienced by long-distance runners and participants in other sports. The source and mechanism of bleeding have been debated. We explain the pathology in a 54-yearold male using cytoscopic evidence. The patient had multiple episodes of painless gross hematuria that occurred immediately after long-distance running. Cystoscopy performed 3 days after an episode revealed multiple erythematous lesions of the posterior bladder wall and prostatic urethra. There was shaggy prostatic urethral mucosa. After a 2-week period without long-distance running, repeat cystoscopy revealed nearly complete resolution of the bladder and prostatatic urethral lesions. Transurethral bladder and prostatic urethral biopsies identified no malignancy or dysplasia. This is one of the few known cases of exercise-induced gross hematuria with evidence of bladder and prostatic abnormalities on cystoscopy. A complete work-up for gross hematuria must be performed to avoid missing an underlying abnormality that presents incidentally or secondary to exertion. UroToday International Journal ® UI J This image was taken in the same area of the posterior wall as the initial cystoscopic image in Figure 1.
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