Intermediate-Term Oncologic Outcomes of Partial Nephrectomy vs Cryoablation in Renal Tumors > 3 cm: A Propensity Score-Matched Analysis.

Purpose: Cryoablation (CA) and partial nephrectomy (PN) are effective nephron-sparing treatments of small renal masses. While guidelines list thermal ablation as an option for tumors < 3 cm, limited data compare PN and CA in larger tumors. We compared intermediate-term oncologic outcomes between PN and CA in renal masses > 3 cm.

Improved stone quality of life in patients with an obstructing ureteral stone on alpha-blocker medical expulsive therapy.

Purpose: Though controversial, alpha blockers are used widely for ureteral stone passage. However, its effects on the patient-reported Quality of life (QOL) is unknown. We compared the QoL of patients on alpha-blocker medical expulsive therapy (MET) to patients not on MET (noMET) utilizing the validated Wisconsin Stone Quality of Life (WISQOL).

A Multi-Institutional Matched-Pair Analysis of Robotic Partial Nephrectomy for Single Multiple Ipsilateral Renal Masses.

Nephron-sparing surgery is important in patients with multiple renal tumors, especially if associated with a solitary kidney or hereditary syndrome. Prior studies have shown partial nephrectomy (PN) of multiple ipsilateral renal masses to have good oncologic and renal function outcomes. We aim to compare renal function changes, complications, and warm ischemia time (WIT) of partial nephrectomy of a single renal mass (sPN) those of partial nephrectomy of multiple ipsilateral renal masses (mPN).

Intrarenal Pressure with Vacuum-Assisted Ureteral Access Sheaths Using an Cadaveric Porcine Model.

Vacuum-assisted ureteral access sheaths (V-UASs) are a new tool designed to evacuate dust or small fragments during retrograde intrarenal surgery (RIRS). There are reports of increased stone-free rates, decreased infections, and decreased operative time with V-UAS usage. The optimal technique and setting for V-UAS has yet to be described.

Factors Associated with Ureteral Stent Failure in Patients with Malignant Ureteral Obstruction.

Management of malignant ureteral obstruction (MUO) with ureteral stents remains a clinical challenge, often involving frequent stent exchanges attributable to stent failure or other urological complications. We report our institutional experience with ureteral stents for management of MUO, including analysis of clinical factors associated with stent failure. We performed a retrospective review of patients treated with indwelling ureteral stents for MUO in nonurothelial malignancies at our tertiary-care institution between 2008 and 2019.

Contemporary Pure Laparoscopic Robot-Assisted Laparoscopic Radical Nephrectomy: Is the Transition Worth It?

The proportion of robotic procedures continues to rise. The literature reinforces that robotic procedures take longer and are often more costly. We compared cost and perioperative outcomes of laparoscopic radical nephrectomy (LRN) and robot-assisted radical nephrectomy (RARN) at our high-volume center.

Incisional Lumbodorsal Hernias Following Retroperitoneal Robotic Partial Nephrectomies for Small Renal Masses at a High-Volume Tertiary Referral Center.

Herein we evaluate the incidence of incisional lumbodorsal hernia (ILDH) after retroperitoneal robotic partial nephrectomy (RRPN) and associated patient-specific and tumor-specific risk factors. Furthermore, we aim to evaluate the role of routine lumbodorsal fascial closure for the prevention of ILDH. This is a retrospective review of our robotic partial nephrectomy database of all RRPNs performed at Washington University School of Medicine from 2000 to 2020.

Racial Comparison of Patients Undergoing Minimally Invasive Partial Nephrectomy for Renal Masses at a Large Volume Tertiary Center.

African American (AA) race has been identified to have a higher incidence of chronic kidney disease (CKD) and worse renal cancer survival compared with Caucasian Americans (CA), irrespective of tumor size, pathologic type, and surgical procedure. We aimed to compare the outcomes between CA and AA patients undergoing minimally invasive partial nephrectomy (PN) at our high-volume center. We queried our PN data repository from 2007 to 2017.

Role of the androgen, estrogen, and progesterone receptors in adherent perinephric fat in robotic partial nephrectomy.

To determine whether androgen, estrogen, and/or progesterone signaling play a role in the pathophysiology of adherent perinephric fat (APF). We prospectively recruited patients undergoing robotic assisted partial nephrectomy during 2015-2017. The operating surgeon documented the presence or absence of APF.

A Case Series of Delayed Proximal Ureteral Strictures After Nephron-Sparing Treatment of Renal Masses.

Delayed proximal ureteral stricture (DPUS) after nephron-sparing treatment (partial nephrectomy [PN] and image-guided percutaneous ablation) of renal masses is a rare complication that occurs because of an unrecognized injury to the proximal ureter and/or its associated vascular supply. We present a multi-institutional series of patients who developed DPUS after nephron-sparing treatment and review relevant tumor characteristics, timing of DPUS presentation, presenting symptoms, and outcome of stricture management. Between 2000 and 2019, nine patients (five PN and four ablation) were found to have DPUS diagnosed at an average of 9 (6-119) months after PN and 5.

Analysis of Ureteral Diameter and Peristalsis in Response to Irrigant Fluid Temperature Changes in an Porcine Model.

It has been previously reported that warming irrigation fluid higher than body temperature may decrease ureteral spasm and thereby facilitate ureteroscopic access to the proximal ureter. Our objective was to examine the effects on ureteral peristalsis and ureteral diameter if the irrigant was warmed to just under the biological threshold for injury. Two female adult Yorkshire pigs were studied in this pilot study.

Positive Surgical Margins After Robot-Assisted Partial Nephrectomy Predict Long-Term Oncologic Outcomes for Clinically Localized Renal Masses.

For patients with clinically localized renal masses, positive surgical margins (PSMs) after robotic partial nephrectomy (RPN) have been associated with a higher risk of disease recurrence, although some studies have challenged this conclusion. Owing to inconsistent reports and a lack of long-term robotic data, the clinical impact of PSM after RPN remains uncertain. We evaluate long-term (>6 years) survival outcomes after RPN in patients with clinically localized disease with respect to surgical margin status.

Laparoscopic cytoreductive nephrectomy is associated with significantly improved survival compared with open cytoreductive nephrectomy or targeted therapy alone.

The aim of the present study was to compare the survival outcomes for patients with metastatic renal cell carcinoma (mRCC) who underwent laparoscopic cytoreductive nephrectomy (CN) vs. open CN vs. targeted therapy (TT) alone at our institution.

Evaluation of Perirenal Anatomic Landmarks on Computed Tomography to Reduce the Risk of Thoracic Complications During Supracostal Percutaneous Nephrolithotomy.

Supracostal access for percutaneous nephrolithotomy (PNL) has a known increased risk for thoracic complications (TCs). In this study, we perform a radiological review of preoperative and postoperative abdominal CT scans to assess the relationship of the upper pole of the kidney with surrounding landmarks to determine radiographic predictors of TCs. We performed a retrospective matched cohort comparison of patients who underwent supracostal PNL with and without TCs from 2012 to 2019.

Utility of a Pigtail Cope Loop Catheter for Bladder Drainage in Treating a Large/Persistent Urethrovesical Anastomotic Leak Following Radical Prostatectomy.

A large or persistent urethrovesical anastomotic leakage after a laparoscopic or robot-assisted laparoscopic radical prostatectomy (RALRP) although infrequent can be a difficult complication to treat. We describe a simple technique to facilitate resolution of a urethrovesical anastomotic leak by exchanging the in-place bladder Foley catheter for a pigtail drainage catheter. Between 2014 and 2019, we had three patients who had a large/persistent urine leak after a radical prostatectomy (one laparoscopic and two robot assisted).

Systemic inflammatory response syndrome in patients with acute obstructive upper tract urinary stone: a risk factor for urgent renal drainage and revisit to the emergency department.

Background: In patients seen in the emergency department (ED) with acute stone obstruction many risk factors that indicate need for urgent renal drainage are known. However, in patients discharged from ED without renal drainage factors that can minimize revisit to the emergency department are not fully identified. We evaluated SIRS (systemic inflammatory response syndrome) as a risk factor for urgent renal drainage and revisit to the ED in patients with acute stone colic during their ED visit.

Ten-Year Experience with Percutaneous Cryoablation of Renal Tumors: Tumor Size Predicts Disease Progression.

Percutaneous cryoablation (PCA) has emerged as an alternative to extirpative management of small renal masses (SRMs) in select patients, with a reduced risk of perioperative complications. Although disease recurrence is thought to occur in the early postoperative period, limited data on long-term oncologic outcomes have been published. We reviewed our 10-year experience with PCA for SRMs and assessed predictors of disease progression.

Dual-frequency setting for urinary stone fragmentation during shock wave lithotripsy: an in vitro study.

Extracorporeal shock wave lithotripsy (SWL) is less invasive compared to the other invasive modalities of stone treatment that are gaining popularity. Hence, methods to improve the efficacy of SWL are desirable. We studied the effectiveness of dual frequency on the efficacy of stone fragmentation, but minimizing treatment time.

A single-nucleus RNA-sequencing pipeline to decipher the molecular anatomy and pathophysiology of human kidneys.

Defining cellular and molecular identities within the kidney is necessary to understand its organization and function in health and disease. Here we demonstrate a reproducible method with minimal artifacts for single-nucleus Droplet-based RNA sequencing (snDrop-Seq) that we use to resolve thirty distinct cell populations in human adult kidney. We define molecular transition states along more than ten nephron segments spanning two major kidney regions.

Large Renal Arteriovenous Malformation in a Patient With von Willebrand Disease.

We describe a rare case of a large renal arteriovenous malformation in a patient with von Willebrand disease. Initial attempts at technically challenging embolization failed requiring a nephrectomy. Extra-intestinal vascular malformations are rare in von Willebrand disease.