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Radio frequency ablation treatment success of the small renal mass is strongly correlated with tumor size. Radio frequency ablation provides excellent and durable outcomes, particularly in tumors smaller than 3 cm. Of tumors 3 cm or larger, approximately 20% will recur such that alternative treatment techniques should be considered. However, most treatment failures are local and are often successfully treated with another ablation session.

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Abbreviations : LPN , laparoscopic partial nephrectomy ; SRBS , self-retaining barbed suture.

SummaryMyxococcus xanthus is a gliding bacterium with a complex life cycle that includes swarming, predation and fruiting body formation. Directed movements in M. xanthus are regulated by the Frz chemosensory system, which controls cell reversals. The Frz pathway requires the activity of FrzCD, a cytoplasmic methyl-accepting chemotaxis protein, and FrzF, a methyltransferase (CheR) containing an additional domain with three tetra trico-peptide repeats (TPRs). CheR methylated FrzCD on three residues, E168, E175 and E182, indicating that the TPRs regulate sitespecific methylation. E168 and E182 were predicted consensus methylation sites, but E175 is methylated on an HE pair. To determine the roles of these sites in vivo, we substituted each methylatable glutamate with either an aspartate or an alanine residue and determined the impact of the point mutants on single cell reversals, swarming and fruiting body formation. Single, double and triple methylation site mutants revealed that each site played a unique role in M. xanthus behaviour and that the pattern of receptor methylation determined receptor activity. This work also shows that methylation can both activate and inactivate the receptor.

Objective• To examine the association of renal morphology with renal function after partial nephrectomy (PN). Patients and Methods• We conducted a multi-institutional retrospective analysis of 322 PNs performed between 2003 and 2011.• The RENAL nephrometry score for each lesion was determined and the estimated glomerular filtration rate (eGFR) was calculated preoperatively and at last follow-up.• We divided patients into two RENAL nephrometry score groups, low (<8) and high (Ն8), and analysed and compared the outcomes of each group. • The primary outcome was median change in eGFR between preoperative and last follow-up (DeGFR). The secondary outcome was eGFR <60 mL/min/1.73m 2 at last follow-up.• Multivariable analysis was conducted to evaluate the risk factors for eGFR <60 mL/min/1.73 m 2 at last follow-up. Results• The median (interquartile range) follow-up was 25.2 (13.5-39.3) months. Low (n = 165) and high (n = 157) RENAL score groups were well-matched for baseline eGFR. The median tumour size (4.2 vs 2.4 cm, P < 0.001) was greater for the high group.• In all, 64% of the low and 88.2% of the high RENAL score group (P < 0.001) had decreased eGFR at last follow-up.• Median eGFR was -7 for the low vs -13.8 mL/min/ 1.73 m 2 for the high group (P = 0.001); eGFR <60 mL/ min/1.73 m 2 at last follow-up was 27.3% for the low vs 37.6% for the high group (P = 0.057).• Linear regression analysis showed that for each 1-point increase in RENAL score, there was 2.5% decrease in eGFR (P = 0.002); for each 1-cm increase in tumour size, there was 1.8% decrease in eGFR (P = 0.013). Area under curve analyses showed no significant difference between RENAL score and tumour size for prediction of de novo eGFR <60 mL/min/1.73 m 2 (P = 0.920) and DeGFR Ն50% (P = 0.85).• Multivariable analysis showed that increasing RENAL score (odds ratio [OR] 1.24, P = 0.046) and decreasing preoperative eGFR (OR 1.10, P < 0.001) were risk factors for eGFR <60 mL/min/1.73 m 2 at last follow-up. Conclusions• Increasing RENAL nephrometry score is an independent risk factor for eGFR <60 mL/min/1.73 m 2 after PN.• RENAL nephrometry score may serve as an additional measure for risk stratification before PN, but further investigation is required.

Study Type – Therapy (case series) Level of Evidence  4 What's known on the subject? and What does the study add? Studies in other surgical populations have found that scarring is a relatively unimportant preoperative patient consideration when compared with surgical cure and safety, but that younger age was a significant factor influencing preference for ‘scarless’ surgery. The present study corroborates the findings of previous series, among patients who were contemplating kidney surgery. OBJECTIVE To evaluate patient attitudes towards cosmesis relative to other considerations, before and after undergoing laparoendoscopic single‐site surgery (LESS) vs laparoscopic/robot‐assisted vs open kidney surgery. METHODS Participants were provided with a survey querying demographic information, surgical history and importance of scarring relative to other surgical outcomes and considerations. The relative importance of each outcome was recorded on a nine‐level ranking scale, ranging from 1 (most important) to 9 (least important). The median scores for each outcome were compared before and after surgery using the Wilcoxon signed‐rank test, and by surgical approach using the Kruskal–Wallis test. The importance of scarring was further analysed according to age (≤50 vs >50 years), surgical indication (oncological vs non‐oncological), gender, and proportion of patients who had undergone previous abdominal surgery. RESULTS A total of 90 patients completed surveys before surgery, of whom 65 (72.2%) also completed surveys after surgery. ‘Surgeon reputation’ and ‘no complications’ were the most important considerations before surgery (median scores 2 and 3, respectively) and after surgery (median scores of 2 for both). ‘Size/number of scars’ was the least important consideration before surgery (median score 8) and the second least important consideration after surgery (median score 7). The median score for ‘size/number of scars’ was significantly higher for the LESS cohort before surgery (laparoscopic/robot‐assisted vs LESS vs open surgery: 8.5 vs 6 vs 9; P = 0.003), but was nonsignificant after surgery (laparoscopic/robotic vs LESS vs open surgery: 7 vs 6.5 vs 7.5; P = 0.83). The median score for ‘size/number of scars’ before surgery was significantly higher for younger patients (P = 0.05) and those with non‐oncological surgical indications (P < 0.001), but there was no significant difference in this outcome for these sub‐groups after surgery. CONCLUSIONS For most patients contemplating urological surgery, cosmesis is of less concern than surgeon reputation and avoidance of surgical complications. Cosmesis may be a more important preoperative consideration for younger patients and those with benign conditions, which warrants further investigation.