Nephron-sparing Techniques Independently Decrease the Risk of Cardiovascular Events Relative to Radical Nephrectomy in Patients with a T1a-T1b Renal Mass and Normal Preoperative Renal Function

The aim of the study was to test the effect of treatment type (nephron sparing surgery vs radical nephrectomy) on the risk of developing cardiovascular event (CVe) after accounting for individual cardiovascular risk. A multi-institutional collaboration including 1331 patients with a clinical T1a-T1b N0 M0 renal mass and normal renal function before surgery (defined as an estimated glomerular filtration rate 6560 ml/min/1.73 m2). We retrospectively colleted data on RN (n=462, 34.7%) or NSS (n=869, 65.3%) between 1987 and 2013. When stratifying for treatment type, the proportion of patients who experienced CVe at 1, 5, and 10 yr was 5.5%, 9.9%, and 20.2% for NSS patients compared to 8.7%, 15.6%, and 25.9%, respectively, for RN patients (p=0.001). In multivariate analyses, patients who underwent NSS showed a significantly lower risk of developing CVe compared with their RN counterparts after accounting for clinical characteristics and cardiovascular profile. Limitations include the retrospective design of the study. The risk of CVe after renal surgery is not negligible. Patients treated with NSS have roughly half the risk of developing CVe relative to their RN counterparts. After accounting for clinical characteristics, comorbidities, and cardiovascular risk at diagnosis, NSS independently decreases the risk of CVe relative to RN

Sexual function in women undergoing hemodialytic treatment assessed using the female sexual function index (FSFI) and the somatic inkblot series (SIS) test

Aims: Female sexuality in end-stage renal disease has so far only been explored using non-validated tools. The aim of this study was to compare sexual function among hemodialyzed (HD) patients and healthy controls using validated questionnaires. Material: Two internationally validated tests have been administrated: the female sexual function index (FSFI) questionnaire and a set of tables from the somatic inkblot series (SIS) test which focus specifically on the area of sexuality. Methods: 25 consecutive HD patients were assessed for sexual function using the FSFI. Nine SIS inkblots concerning sexuality were also administered to obtain more detailed information about the psychological component of sexuality. An equal number of control healthy volunteers perfectly matched for age, marital status and educational level underwent the same evaluations, and the results of the two groups were compared. Results: HD patients had significantly lower scores than the controls for all FSFI domains except sexual desire even when stratified by age and marital status. All sexually related thematic areas of the SIS except body perception were significantly affected in the HD group compared to the control group. Conclusions: Chronic renal failure requiring HD treatment adversely affects female sexual function. The psychological impact on patients is significant when compared to an age-matched control group. Both the FSFI questionnaire and the SIS test may be considered useful tools for an integrated medical and psychological screening of FSD

Risk of recurrence after nephrectomy: Comparison of predictive ability of validated risk models

Objective: To assess accuracy of University of California Los Angeles Integrated Staging System (UISS), Stage, Size, Grade and Necrosis (SSIGN) score, Leibovich score and GRade, Age, Nodes and Tumor (GRANT) score, the ASSURE (Adjuvant Sunitinib or Sorafenib vs. placebo in resected Unfavorable REnal cell carcinoma) score models and seventh American Joint Committee on Cancer (AJCC)/TNM staging system in predicting recurrence-free survival (RFS) in surgically-treated non-metastatic clear cell renal cell carcinoma (ccRCC) patients. Materials and methods: Kaplan-Meier curves and the log-rank test tested RFS according to risk groups among the UISS, SSIGN, Leibovich and GRANT models and the AJCC/TNM system. The Heagerty's C-index for survival tested for discrimination of each model at different time points after nephrectomy. Results: Three hundred and fifty-eight M0 ccRCC patients were included. RFS significantly differed among each risk category for all models (P < 0.001). SSIGN showed the highest c-index over time (from 0.89 at 6-month to 0.82 at 60-month), followed by Leibovich (from 0.89–0.82), AJCC/TNM stage (from 0.82–0.77), ASSURE (from 0.81 to 0.76), GRANT (from 0.83–0.73) and UISS (from 0.76–0.72). For all models, peak discriminatory ability was reached before 12 months. The most prominent decline occurred within 24 months and reaches the lowest discriminatory ability at 60 months. Conclusions: Predictive models, with preference for SSIGN and Leibovich scores, are reliable to predict recurrence after nephrectomy and should be recommended to tailor postoperative surveillance protocols