Trends of Presentation and Clinical Outcome of Treated Renal Angiomyolipoma

PURPOSE: The purpose of this study is to set guidelines for the management of renal angiomyolipoma (AML), clinical prognosis according to tumor size, in association with tuberous sclerosis complex (TSC), multiplicity, radiographic finding, and treatment modality. MATERIALS AND METHODS: Between March 1998 and October 2008, 129 out of 254 patients with AML who underwent surgical intervention or angioembolization were enrolled. Diagnosis of AML was determined by the presence of a low attenuated component on CT imaging or by pathological confirmation. Indications of treatment were intractable pain, hematuria, suspicion of malignancy, large tumor size, spontaneous rupture, and radiographically equivocal tumors in which a differential diagnosis was needed to rule out malignancy. Parameters including age, sex, tumor size, multiplicity, radiographic characteristics, association with TSC, and treatment modality were reviewed. RESULTS: Age at presentation was 50.6 years and mean tumor size was 3.5 cm. Presentation symptoms were flank pain, hematuria, spontaneous rupture, and fatigue. 97 (75.2%) patients were incidentally discovered. 100 (77.5%) were females. 68 (52.7%) underwent nephron-sparing surgery (NSS), 35 (27.1%) radical nephrectomy, and 26 (20.2%) angioembolization. TSC was accompanied in 12 (9.3%) patients. No patient developed renal function impairment during the mean follow-up period of 64.8 months. Patients with TSC presented at a younger age, along with larger, bilateral, and multiple lesions. CONCLUSION: Significant differences in clinical manifestations and treatment outcomes were noted in respect to tumor characteristics, association with TSC, and treatment modality. Considering the benign nature of AML, these parameters ought to be considered when deciding upon active surveillance or prophylactic intervention.ope

Treatment of splenic injury during laparoscopic nephrectomy with BioGlue, a surgical adhesive.

Splenic laceration is a recognized complication of both open and laparoscopic renal surgery. Laparoscopic renal surgery continues to become the new standard of care, and this potentially problematic complication may be encountered during mobilization to gain access to the retroperitoneum. We present 2 cases of splenic injury managed with BioGlue, a new surgical adhesive, during one hand-assisted and one pure laparoscopic nephrectomy. Application of the BioGlue adhesive resulted in satisfactory hemostasis for both injuries without the need for further intervention. These preliminary observations suggest that BioGlue may be a useful addition to the urologic armamentarium to achieve hemostasis in laparoscopic surgery

The Effect of Time to Castration Resistance on Outcomes With Abiraterone and Enzalutamide in Metastatic Prostate Cancer

BACKGROUND: Abiraterone and enzalutamide are 2 novel androgen receptor (AR)-targeting therapies that improve survival in patients with metastatic castration-resistant prostate cancer. The factors that predict abiraterone and enzalutamide response are lacking. The objective of the present study was to determine whether the outcomes from primary androgen deprivation therapy (ADT) could predict the outcomes with subsequent novel AR-targeting therapies. MATERIALS AND METHODS: We identified 80 consecutive patients with metastatic castration-resistant prostate cancer treated with abiraterone or enzalutamide. Cox regression models were used to analyze the relationships between the primary ADT response and the primary outcome of progression-free survival (PFS) after initiating novel hormonal therapy. The secondary outcomes included prostate-specific antigen decline and overall survival. The survival probabilities were plotted using the Kaplan-Meier method, and the differences assessed with the log-rank test. RESULTS: The time to castration resistance with primary ADT showed a significant association with both PFS and overall survival after initiating novel hormone therapy (P = .032 and P = .028, respectively). Patients with progression during primary ADT before 1 year had a median PFS of 3.4 months compared with a median PFS of 7.6 and 8.1 months for patients whose time to castration resistance was ≥ 1 and ≤ 5 years (P = .008) and \u3e 5 years (P = .026), respectively. However, the time to castration resistance was not an independent predictor of survival or the PSA response with novel AR-targeting therapy on multivariate analysis. CONCLUSION: A rapid time to progression during primary ADT was associated with poor outcomes but was not an independent predictor of the response to enzalutamide or abiraterone