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RAPN was associated with a low rate of conversion. Independent predictors of conversion were BMI and Charlson score. Tumor factors such as clinical stage, location, multifocality, or RENAL score were not associated with increased risk of conversion.

Combinations of extracorporeal shockwave lithotripsy (ESWL) and endourological and open surgery have been used for management of forgotten double-J (DJ) stents; however, there are only a few case reports or case series in literature. We present our experience of managing 28 cases of forgotten ureteric stents of whom three patients died because of complications after intervention. We retrospectively reviewed the hospital records of 28 cases of forgotten DJ stents from 2000 to 2013. The details reviewed included indications for stent placement, indwelling time, presenting complaints, laboratory, radiographic, nuclear scan findings, management techniques, and complications. Extensive review of literature was done. Mean patient age was 37.7±14 years. Mean indwelling time was 102.9 months. The commonest presenting complaints were irritative voiding symptoms and hematuria. Nineteen (67.8 %) of the stents were complicated. The complicated stents were managed by a combination of endourological techniques and ESWL. Six (21.5 %) patients presented with renal failure. Three patients died of complications. Forgotten DJ stent can be a lethal yet entirely preventable complication. Preoperative imaging with a noncontrast CT is essential especially in long indwelling time, especially to evaluate stone burden at the upper end of the stent. A stepwise approach should be used for management. Where long operative times are expected, the procedure must be staged.Combined endourological procedures are almost always successful in managing these challenging cases.

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ObjectivesTo analyse the outcomes of robot-assisted partial nephrectomy (RAPN) in patients with a solitary kidney in a large multi-institutional database. Patients and MethodsIn all, 2755 patients in the Vattikuti Collective Quality Initiative database underwent RAPN by 22 surgeons at 14 centres in nine countries. Of these patients, 74 underwent RAPN with a solitary kidney between 2007 and 2016. We retrospectively analysed the functional and oncological outcomes of these 74 patients. A 'trifecta' of outcomes was assessed, with trifecta defined as a warm ischaemia time (WIT) of <20 min, negative surgical margins, and no complications intraoperatively or within 3 months of RAPN. ResultsAll 74 patients underwent RAPN successfully with one conversion to radical nephrectomy. The median (interquartile range [IQR]) operative time was 180 (142-230) min. Early unclamping was used in 11 (14.9%) patients and zero ischaemia was used in 12 (16.2%). Trifecta outcomes were achieved in 38 of 66 patients (57.6%). The median (IQR) WIT was 15.5 (8.75-20.0) min for the entire cohort. The overall complication rate was 24.1% and the rate of ClavienDindo grade ≤II complications was 16.3%. Positive surgical margins were present in four cases (5.4%). The median (IQR) follow-up was 10.5 (2.12-24.0) months. The median drop in estimated glomerular filtration rate at 3 months was 7.0 mL/min/1.72 m 2 (11.01%). ConclusionOur findings suggest that RAPN is a safe and effective treatment option for select renal tumours in solitary kidneys in terms of a trifecta of negative surgical margins, WIT of <20 min, and low operative and perioperative morbidity.