Management of Renal Masses and Localized Renal Cancer: Systematic Review and Meta-Analysis

https://www.europeanurology.com/article/S0302-2838(15)00068-8/pdf/renal-ischemia-and-function-after-partial-nephrectomy-a-collaborative-review-of-the-literature

Renal Ischemia and Function After Partial Nephrectomy: A Collaborative Review of the Literature

https://www.imop.gr/sites/default/files/a-literature-review-of-renal-surgical-anatomy-and-surgical_-strategies-for-partial-nephrectomy.pdf

A Literature Review of Renal Surgical Anatomy and Surgical Strategies for Partial Nephrectomy

https://www.europeanurology.com/article/S0302-2838(14)00807-0/pdf/mayo-adhesive-probability-score-an-accurate-image-based-scoring-system-to-predict-adherent-perinephric-fat-in-partial-nephrectomy

Mayo Adhesive Probability Score: An Accurate Image-based Scoring System to Predict Adherent Perinephric Fat in Partial Nephrectomy

Objectives
To evaluate and compare the correlations between Preoperative Aspects and Dimensions Used for an Anatomical (PADUA) and R.E.N.A.L. [Radius (tumour size as maximal diameter), Exophytic/endophytic properties of the tumour, Nearness of tumour deepest portion to the collecting system or sinus, Anterior (a)/posterior (p) descriptor and the Location relative to the polar line] nephrometry scores and perioperative outcomes and postoperative complications in a multicentre, international series of patients undergoing robot-assisted partial nephrectomy (RAPN) for masses suspicious for renal cell carcinoma (RCC).

Patients and Methods
We retrospectively evaluated the clinical records of patients who underwent RAPN between 2010 and 2013 for clinical N0M0 renal tumours in four international centres that completed all the data required for the Vattikuti Global Quality Initiative in Robotic Urologic Surgery (GQI-RUS) database. All patients underwent preoperative computed tomography or magnetic resonance imaging to define the clinical stage and anatomical characteristics of the tumours. PADUA and R.E.N.A.L. scores were retrospectively assessed in each centre. Univariate and multivariate analyses were used to evaluate the correlations between age, gender, Charlson comorbidity index, clinical tumour size, PADUA and R.E.N.A.L. complexity group categories and warm ischaemia time (WIT) of >20 min, urinary calyceal system closure, and grade of postoperative complications.

Results
Overall, 277 patients were evaluated. The median (interquartile range) tumour size was 33.0 (22.0–43.0) mm. The median PADUA and R.E.N.A.L. scores were eight and seven, respectively; 112 (40.4%), 86 (31.0%) and 79 (28.5%) patients were classified in the low-, intermediate- or high-complexity group according to PADUA score, while 118 (42.5%), 139 (50.1%) and 20 (7.2%) were classified in the low-, intermediate- or high-complexity group according to R.E.N.A.L. score, respectively. Both nephrometry tools significantly correlated with perioperative outcomes at univariate and multivariate analyses.

Conclusion
A precise stratification of patients before PN is recommended to consider both the potential threats and benefits of nephron-sparing surgery. In our present analysis, both PADUA and R.E.N.A.L. were significantly associated with predicting prolonged WIT and high-grade postoperative complications after RAPN.

/pdf/padua-and-r-e-n-a-l-nephrometry-scores-correlate-with-2pt0kcp2og.pdf

PADUA and R.E.N.A.L. nephrometry scores correlate with perioperative outcomes of robot-assisted partial nephrectomy: analysis of the Vattikuti Global Quality Initiative in Robotic Urologic Surgery (GQI-RUS) database.

Background and Purpose: The discovery of thick, adherent, perinephric sticky fat (PSF) is relatively common during open or laparoscopic retroperitoneal surgery. To our knowledge, however, ...

Association of Clinical and Radiographic Features with Perinephric “Sticky” Fat

Introduction: Urologists are increasingly exposed to fluoroscopy, which can cause cellular damage. Appropriate awareness and safety precautions concerning fluoroscopy are necessary and lik...

/pdf/assessment-of-radiation-safety-knowledge-among-urology-1wb0sn2xqu.pdf

Assessment of Radiation Safety Knowledge Among Urology Residents in the United States

This article describes the case of a 51-year-old woman with acute renal failure. Bylund and Pais detail the investigations that the patient underwent, the discovery of bilateral, multifocal malacoplakia lesions of the bladder and ureters, and the patient's management with medical therapy and surgery. This case emphasizes that upper urinary tract malacoplakia can present as an aggressive disease, but that renal preservation can be achieved. Background A 51-year-old woman with a history of hypertension and a 5-year history of recurrent perimenopausal Escherichia coli urinary tract infections presented with fatigue. She had a history of occasional urinary frequency, but denied gross hematuria, flank pain, abdominal pain, immunodeficiency or immunosuppression. Investigations Basic metabolic profile, ultrasonography, cystoscopy, retrograde pyelography, pathologic evaluation of resected lesions from the bladder, ureteroscopy, pathologic evaluation of resected lesions from the ureters, and MRI. Diagnosis Acute renal failure caused by bilateral, multifocal malacoplakia lesions of the bladder and ureters. Management Endoscopic resection and laser ablation, ureteral stent placement, and medical treatment with fluoroquinolones, vitamin C and bethanechol.

A case of acute renal failure caused by bilateral, multifocal malacoplakia lesions of the bladder and ureters

OBJECTIVES AND BACKGROUND: We describe a novel approach for removal of a retained, heavily encrusted ureteral stent via combined laparoscopic cystolithotomy and pyelolithotomy. Due to noncompliance, our patient with a history of nephrolithiasis returned with large proximal and distal stones 2.5 years after placement of a left ureteral stent. METHODS: Laparoscopy was performed using three 12 mm ports and two 5 mm ports. The bladder was opened in the midline and the stent divided at the ureteral orifice. The bladder stone (4.7 cm x 4 cm) was placed in a retrieval bag and the cystotomy closed with vicryl suture. The proximal ureter and renal pelvis were dissected free and incised. The stent with 2.3 cm x 1.5 cm stone on the proximal curl was removed. The incision was closed transversely with vicryl suture. RESULTS: The patient's recovery was uneventful, including drain removal prior to discharge on postoperative day 3. The foley was removed after a negative cystogram 7 days later. Analysis revealed calcium phosphate and struvite stones. Left ureteroscopy 2 months later revealed a widely patent proximal ureter. No complications have been identified. CONCLUSIONS: Laparoscopic cystolithotomy with stent division combined with pyelolithotomy can be performed safely and successfully as a single procedure to remove the heavily encrusted ureteral stent.

Novel approach for removal of heavily encrusted ureteral stent.

Implementing a Root Cause Analysis Program to Enhance Patient Safety Education in Urology Residency.

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