Retroperitoneoscopic renal biopsy in children

OBJECTIVE: We present our experience in a series of 17 consecutive pediatric patients submitted to retroperitoneal laparoscopic renal biopsy. MATERIALS AND METHODS: Retroperitoneal laparoscopic renal biopsy (LRB) was performed in 5 boys and 12 girls. Mean age was 8.1 years and age range from 2 to 12. Two or three trocars were used to expose the inferior pole of the kidney, remove enough cortical parenchymal specimen and fulgurate the biopsy site. Assessment included surgical time, estimated blood loss, hospitalization period, analgesia requirements, complications and number of glomeruli present in the specimen. RESULTS: LRB was successfully performed in all 15 patients (88%). In two cases, LRB was not possible to be performed. One patient was converted to a transperitoneal laparoscopy due to tear in the peritoneum. The other patient had had previous abdominal surgery and, during retroperitoneal balloon dilation, the peritoneum was opened and the open biopsy was performed. A third patient had postoperatively a perirenal hematoma, which was solved spontaneously. Complication rate was 17.6% (3/17 cases). Mean operative time was 65 minutes, while mean estimated blood loss was 52 mL, mean hospital stay was 2.2 days and mean analgesic requirement was 100 mg of tramadol. The mean number of glomeruli present in the specimen was 60. CONCLUSION: Retroperitoneal laparoscopic renal biopsy in children is a simple, safe. Bleeding is still the most common complication. However, direct vision usually allows a safe control of this drawback. In our institution, laparoscopic approach is the chosen procedure in pediatric patients older than one - year - old

Side Effects of Medical Cancer Therapy in Genitourinary Malignancies

Genitourinary cancers represent 12.8% of cancer in both sexes and 21.5% in men, accounting for 7% of cancer deaths in both sexes and 10.5% in men. The systemic treatment of prostate cancer and renal cell carcinoma does not rely on chemotherapy, with the exception of taxane docetaxel and cabazitaxel. Prostate cancer is primarily treated by androgen deprivation, by surgical castration or LHRH analogs, or by androgen receptor pathway inhibitor enzalutamide and abiraterone acetate. Renal cell carcinoma is nowadays treated with agents targeting survival and angiogenesis pathways, including tyrosine kinase inhibitors (TKIs) sorafenib, sunitinib, axitinib, and pazopanib; anti-vascular endothelial growth factor (VEGF) monoclonal antibody bevacizumab; mammalian target of rapamycin (mTOR) inhibitors temsirolimus and everolimus; and oral inhibitor of tyrosine kinases MET, VEGFR, AXL, cabozantinib. Most recently, immune checkpoint inhibitors have made their way to genitourinary cancers, revolutionizing the treatment of urothelial cancers and renal cell carcinoma. Hormone therapies and targeted therapies don’t eradicate prostate cancer and renal cell carcinoma but rather switch them to a more chronic state. This means that these treatments are prescribed chronically for an extended period of time. In such conditions, even the least bothersome side effect may profoundly alter the quality of life of patients. Ultimately, this is a threat to compliance and then to the efficacy of these treatments. In addition, many of the side effects of these drugs often overlap with common chronic illnesses such as diabetes, hypertension, hypercholesterolemia, heart failure, and osteoporosis. An exhaustive knowledge of these side effects, proper monitoring, and in-depth education of patients are key elements to secure the efficacy of these treatments