What ' s known on the subject? and What does the study add? Pathological stage, lymph node metastasis and tumour grade have been established as prognostic factors for upper-tract urothelial carcinoma, but there are few studies to date assessing location within the ureter as a prognostic factor. There are also few studies comparing surgical approaches to radical nephroureterectomy (NU), partial ureterectomy and endoscopic resection (ENDO) with regard to oncological outcomes.This study did not fi nd any prognostic signifi cance for tumour location or surgical approach with regard to outcomes in patients with ureteric tumours. Although NU is the standard treatment for invasive ureteric tumours, partial ureterectomy and ENDO can safely be performed in selected patients. Despite the risk of a shorter time to recurrence, ENDO can be recommended in low grade, non-invasive ureteric tumours but only with close, thorough surveillance practices. OBJECTIVE• To assess the impact of tumour location within the ureter and the impact of surgical approach on recurrence-free survival (RFS) and cancer-specifi c survival (CSS) with regard to ureteric tumours. PATIENTS AND METHODS• Data were retrospectively reviewed from 60 patients with isolated primary ureteric tumours, treated at a single tertiary referral centre.• Patients were treated with radical nephroureterectomy (NU, n = 33), partial ureterectomy ( n = 17) or endoscopic resection (ENDO, n = 10).• Kaplan -Meier curves were used for the analysis of RFS and CSS after surgery, stratifi ed by tumour location and surgical approach. RESULTS• With a median follow-up of 29 months, tumour location was not associated with disease recurrence ( P = 0.423).• The ENDO group had shorter time to disease recurrence.• There were no signifi cant differences in the probability of CSS with regard to either tumour location or surgical approach ( P = 0.523 and P = 0.904, respectively). CONCLUSIONS• Tumour location or surgical approach were not signifi cant predictors of oncological outcomes in patients with ureteric tumours.• Although NU is standard treatment for invasive ureteric tumours, partial ureterectomy and ENDO can safely be performed in selected patients. Despite the risk of a shorter time to recurrence, ENDO can be recommended in low grade, non-invasive ureteric tumours.• All urothelium-preserving approaches require thorough surveillance. KEYWORDSureteric tumour , tumour location , surgical approach , recurrence-free survival , cancer-specifi c survival Study Type -Therapy (case series) Level of Evidence 4
Anastomosing hemangiomas are rare variants of vascular tumors found in adrenal, hepatic, and gastrointestinal tissue. Frequently, renal anastomosing hemangiomas are misdiagnosed on computed tomography (CT) as kidney cancers, resulting in unnecessary workups and detrimental treatments. We present a rare case of bilateral renal and adrenal anastomosing hemangioma found incidentally on renal biopsy. Patient is a 39 year-old African American male on hemodialysis with a history of end-stage renal disease secondary to lupus who presented with acute pericarditis and worsening renal insufficiency.
CBCT may provide advantages of improved preoperative imaging, which may result in better percutaneous access, and improved postoperative imaging, which allows surgeons to have "real-time" access to CT quality images. The intraoperative availability of these high quality tomographic images may obviate the need for other postoperative imaging and subsequent adjunctive procedures for residual fragments.
What ' s known on the subject? and What does the study add?With the advancement of minimally invasive surgery, the management of small renal masses (SRM) has dramatically changed. Ablative technology such as radiofrequency ablation (RFA) and cryoablation have emerged as viable alternative modalities to extirpative surgery. RFA is one of the most studied and applied energy-based, needle-ablative treatment modalities, with encouraging mid-and long-term oncological outcomes. Monopolar devices have several shortcomings. The electrodes are susceptible to the cooling effect of nearby blood vessels that act as a ' heat sink ' , limiting the extent of tissue ablation and forming lesions with asymmetric borders and ' skip lesions ' . Therefore, it is diffi cult to monitor and accurately predict the size of ablated lesions.
Introduction: Unmet social needs lead to adverse health outcomes and contribute to health inequities. Efforts to screen for social determinants of health (SDOH) have occurred primarily within primary care. Here, we describe the feasibility of implementing a workflow for SDOH screening within 2 urology clinics in Charlotte, North Carolina. Methods: Our pilot was adapted from the WE CARE Model, which integrates a referral to community resources for patients identified with social needs and an optional followup with a navigator for additional assistance. Patients were screened with the validated Healthy Opportunities SDOH tool to assess food, housing, utilities, transportation and physical safety needs; 40 patients were screened at 2 urology clinics, totaling 80 patients. Surveys were sent to 16 clinicians and staff who participated in the pilot to assess feasibility of implementation.Results: In all, 24/80 patients (30%) were screened for 1 or more social needs, with food and housing being the most frequent; 20/24 patients with social need (83%) successfully received a community resource guide, and 13 of those patients also requested a referral. All survey respondents either agreed or strongly agreed that screening was valuable and allowed them to better understand the needs of their patients. They also felt that understanding SDOH aligns with departmental goals and mission.Conclusions: Our results suggest that SDOH screening within a urological setting is feasible, and dedicated support staff should be available to ensure adequate followup for patients with unmet needs. Future work is needed to expand resources for patients and optimize workflow for clinicians.
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