The comparative effectiveness of partial nephrectomy versus radical nephrectomy to preserve kidney function has not been well established. We determined the risk of clinically significant (stage 4 and higher) CKD after radical or partial nephrectomy among veterans treated for kidney cancer in the Veterans Health Administration (2001-2013). Among patients with preoperative eGFR≥30 ml/min per 1.73 m, the incidence of CKD stage 4 or higher after radical (=9759) or partial nephrectomy (=4370) was 7.9% overall. The median time to stage 4 or higher CKD after surgery was 5 months, after which few patients progressed. In propensity score-matched cohorts, partial nephrectomy associated with a significantly lower relative risk of incident CKD stage 4 or higher (hazard ratio, 0.34; 95% confidence interval [95% CI], 0.26 to 0.43, versus radical nephrectomy). In a parallel analysis of patients with normal or near-normal preoperative kidney function (eGFR≥60 ml/min per 1.73 m), partial nephrectomy was also associated with a significantly lower relative risk of incident CKD stage 3b or higher (hazard ratio, 0.15; 95% CI, 0.11 to 0.19, versus radical nephrectomy) in propensity score-matched cohorts. Competing risk regression models produced consistent results. Finally, patients treated with a partial nephrectomy had reduced risk of mortality (hazard ratio, 0.55; 95% CI, 0.49 to 0.62). In conclusion, compared with radical nephrectomy, partial nephrectomy was associated with a marked reduction in the incidence of clinically significant CKD and with enhanced survival. Postoperative decline in kidney function occurred mainly in the first year after surgery and appeared stable over time.

OBJECTIVES To assess whether patient factors, such as age and preoperative kidney function, were associated with receipt of partial in a national integrated health care system. METHODS We identified patients treated with a radical or partial nephrectomy from 2002-2014 in the Veterans Health Administration. We examined associations among patient age, sex, race/ethnicity, multi-morbidity, baseline kidney function, tumor characteristics and receipt of partial nephrectomy. We estimated the odds of receiving a partial nephrectomy and assessed interactions between covariates and the year of surgery to explore whether patient factors associated with partial nephrectomy changed over time. RESULTS In our cohort of 14,186 patients, 4,508 (31.2%) received a partial nephrectomy. Use of partial nephrectomy increased from 17% in 2002, to 32% in 2008, and to 38% in 2014. Patient race/ethnicity, age, tumor stage, and year of surgery were independently associated with receipt of partial nephrectomy. Black veterans had significantly increased odds of receipt of partial nephrectomy, while older patients had significantly reduced odds. Partial nephrectomy utilization increased for all groups over time, but older patients, and patients with worse baseline kidney function showed the least increase in odds of partial nephrectomy. CONCLUSIONS While the utilization of partial nephrectomy increased for all groups, the greatest increase occurred in the youngest patients and those with the highest baseline kidney function. These trends warrant further investigation to ensure that patients at the highest risk of impaired kidney function are considered for partial nephrectomy whenever possible.

Vasectomized fathers have a higher proportion of sons compared with non-vasectomized fathers, suggesting that offspring sex ratio is associated with a man's decision to undergo vasectomy. Further research is indicated to understand how offspring sex ratio impacts a man's contraceptive decisions.

Introduction Men who are considering vasectomy as a means of contraception may have significant anxiety about their future sexual potency. As a result, couples may choose other forms of contraception with lower efficacy. Aim We sought to determine the relationship between vasectomy and the frequency of sexual intercourse. Methods We analyzed data from cycles 6 (2002) to 7 (2006–2008) of the National Survey of Family Growth to compare the frequency of sexual intercourse of men who had undergone vasectomy with men who had not. Analysis was performed using data from male and female responders, and excluded men who had never had sex and those below age 25. We constructed a multivariate logistic regression model to adjust for demographic, socioeconomic, reproductive, and health factors. Main Outcome Measure The main outcome measure was the sexual frequency in the last 4 weeks. Results Among male responders, a total of 5838 men met criteria for our study; 353 had undergone vasectomy. For vasectomized men, the average frequency of sexual intercourse was 5.9 times per month compared with 4.9 times for nonvasectomized men. After adjusting for age, marital status, race, education, health, body mass index, children, and income, vasectomized men had an 81% higher odds (95% confidence interval [CI] 6–201%) of having intercourse at least once a week compared with nonvasectomized men. A total number of 5211 female respondents reported 670 of their partners had undergone vasectomy. For partners of vasectomized men, the average frequency of intercourse was 6.3 times per month, compared with 6.0 times for partners of nonvasectomized men. After adjustment, women with vasectomized partners had a 46% higher odds (95% CI 5–103%) of having sexual intercourse at least once a week compared with women with nonvasectomized partners (P = 0.024). Conclusion Vasectomy is not associated with decreased sexual frequency. This finding may be helpful to couples as they consider contraceptive options.

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