Open Partial Nephrectomy in the Management of Small Renal Masses

Introduction. Most of the kidney masses are being detected incidentally with smaller size due to widespread use of imaging modalities leading to increased RCC incidence worldwide with an earlier stage. This article reviews the role of open partial nephrectomy (PN) in the management of small renal masses. Material and Methods. Review of the English literature using MEDLINE has been performed between 1963–2008 on small renal masses, partial nephrectomy, kidney cancer, nephron sparing surgery (NSS), radical nephrectomy, laparoscopy, and surgical management. Special emphasis was given on the indications of NSS, oncological outcomes and comparison with open and laparoscopic PN. Results. Overall 68 articles including 31 review papers, 35 human clinical papers, 1 book chapter, and 1 animal research study were selected for the purpose of this article and were reviewed by the authors. Conclusions. Currently, open NSS still remains as the gold standard surgical treatment modality in patients with small renal masses

Современные подходы к лечению почечно-клеточного рака

Surgery is the only effective method for the treatment of localized renal cell carcinoma (RCC). Today nephron sparing surgery (NSS) cures the majority of patients with early stage disease. Open radical nephrectomy (RN) is performed mainly in patients with large tumors and in cases complicated by the tumor thrombus extension into the vena cava. Laparoscopy is now more and more often used for RCC treatment. Laparoscopic RN (LRN) is now recommended for the treatment of early stage RCC, when NSS cannot be used. LRN seems to provide longterm cancer control comparable to open RN. RCC is now often diagnosed when the tumors are still small and can be often cured by NSS providing excellent local cancer control. Tumor size, location, multiple foci, surgical margin, and pathological variants are significant for cancer outcome in selective NSS. Laparoscopic partial nephrectomy (LPN) is now gaining popularity as an effective minimally invasive treatment in patients with relatively small and peripheral renal tumors. Recently minimally invasive ablative techniques were introduced for the treatment of RCC. These methods involve little complications if used for the treatment of small renal tumors. The currently used best therapy for metastatic RCC is inadequate and surgery is an important component of combined treatment including immunochemotherapy. Combinations of interferon-alpha, interleukin-2, and 5-fluorouracyl are now used for the treatment of metastatic RCC. Nephrectomy can be recommended for patients with good performance status before immunotherapy. Modern research is focused on identification of novel agents and treatment modalities with better antitumor activity.

A new outcome measure for LUTS: Symptoms of Lower Urinary Tract Dysfunction Research Network Symptom Index‐29 (LURN SI‐29) questionnaire

AimsTo develop a representative, self‐report assessment of lower urinary tract symptoms (LUTS) for men and women, the symptoms of Lower Urinary Tract Dysfunction Research Network Symptom Index‐29 (LURN SI‐29).MethodsWomen and men seeking treatment for LUTS at one of six academic medical centers in the US were assessed at baseline, 3‐month and 12‐month intervals. Twelve‐month data on 78 LURN SI‐29 items were analyzed among 353 women and 420 men using exploratory factor analysis (EFA), with factor structure confirmed using confirmatory factor analysis (CFA). Internal consistency, reliability, and validity of the five developed scales were evaluated by assessing correlations with the American Urological Association Symptom Index (AUA‐SI), the genitourinary pain index (GUPI), and the Pelvic Floor Distress Inventory‐20 (PFDI‐20), and by examining expected sex differences in scores.ResultsEFA results (n = 150 women; 150 men) produced an interpretable eight‐factor solution, with three of the factors comprised of dichotomous items addressing LUTS‐associated sensations. The remaining five factors, confirmed with CFA in an independent sample of 473 participants, produced five scales: incontinence, urgency, voiding difficulty, bladder pain, and nocturia. Subscales and total LURN SI‐29 scores were correlated as expected with AUA‐SI, GUPI, and PFDI‐20. LURN SI‐29 scores also performed as expected in differentiating men from women based upon clinically expected differences, with men reporting more voiding difficulties and nocturia, and women reporting more urgency and incontinence.ConclusionsThe LURN SI‐29 questionnaire has the potential to improve research and clinical outcome measurement for both men and women with LUTS.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/150585/1/nau24067.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/150585/2/nau24067_am.pd

Quality of life impact and recovery after ureteroscopy and stent insertion: Insights from daily surveys in STENTS

BACKGROUND: Our objective was to describe day-to-day evolution and variations in patient-reported stent-associated symptoms (SAS) in the STudy to Enhance uNderstanding of sTent-associated Symptoms (STENTS), a prospective multicenter observational cohort study, using multiple instruments with conceptual overlap in various domains. METHODS: In a nested cohort of the STENTS study, the initial 40 participants having unilateral ureteroscopy (URS) and stent placement underwent daily assessment of self-reported measures using the Brief Pain Inventory short form, Patient-Reported Outcome Measurement Information System measures for pain severity and pain interference, the Urinary Score of the Ureteral Stent Symptom Questionnaire, and Symptoms of Lower Urinary Tract Dysfunction Research Network Symptom Index. Pain intensity, pain interference, urinary symptoms, and bother were obtained preoperatively, daily until stent removal, and at postoperative day (POD) 30. RESULTS: The median age was 44 years (IQR 29,58), and 53% were female. The size of the dominant stone was 7.5 mm (IQR 5,11), and 50% were located in the kidney. There was consistency among instruments assessing similar concepts. Pain intensity and urinary symptoms increased from baseline to POD 1 with apparent peaks in the first 2 days, remained elevated with stent in situ, and varied widely among individuals. Interference due to pain, and bother due to urinary symptoms, likewise demonstrated high individual variability. CONCLUSIONS: This first study investigating daily SAS allows for a more in-depth look at the lived experience after URS and the impact on quality of life. Different instruments measuring pain intensity, pain interference, and urinary symptoms produced consistent assessments of patients\u27 experiences. The overall daily stability of pain and urinary symptoms after URS was also marked by high patient-level variation, suggesting an opportunity to identify characteristics associated with severe SAS after URS

Are three‐day voiding diaries feasible and reliable? Results from the Symptoms of Lower Urinary Tract Dysfunction Research Network (LURN) cohort

AimsThe aims of this study were to assess the completeness of voiding diaries in a research context and to correlate diary data with patient‐reported questionnaires.MethodsMen and women enrolled in the Symptoms of Lower Urinary Tract Dysfunction Research Network (LURN) were given a 3‐day voiding and fluid‐intake diary to fill‐out. Diaries were assessed for completeness and intake‐output imbalances. They were assigned to one of four categories based on a percentage of missing data and fluid imbalance: no diary submitted, unusable (>40% missing void or intake volumes, or unphysiological fluid imbalance), usable but not complete, and complete.ResultsA total of 1064 participants were enrolled and 85% (n = 902) returned the bladder diary. Of the diaries returned, 94% (n = 845) had data on three separate days, 87% (n = 786) had no missing intake volumes, 61% (n = 547) had no missing voided volumes, and 70% (n = 635) had a fluid imbalance within 3 L across the 3‐day time period, resulting in 50% (n = 448) of participants with 100% complete diaries. Younger age was associated with a higher likelihood of not submitting a diary, or submitting an unusable diary. Women had a higher likelihood of submitting an unusable diary or a usable but incomplete diary.ConclusionOverall, 50% of LURN participants returned voiding diaries with perfectly complete data. Incomplete data for voided volumes was the most common deficiency. There was only a moderate correlation between diary data and questionnaire responses, indicating that diaries are a source of unique information.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/152022/1/nau24113.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/152022/2/nau24113_am.pd

Bowel function, sexual function, and symptoms of pelvic organ prolapse in women with and without urinary incontinence

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/146399/1/nau23587_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/146399/2/nau23587.pd

Metabolic diagnosis and medical prevention of calcium nephrolithiasis and its systemic manifestations: a consensus statement

Background: Recently published guidelines on the medical management of renal stone disease did not address relevant topics in the field of idiopathic calcium nephrolithiasis, which are important also for clinical research. Design: A steering committee identified 27 questions, which were proposed to a faculty of 44 experts in nephrolithiasis and allied fields. A systematic review of the literature was conducted and 5216 potentially relevant articles were selected; from these, 407 articles were deemed to provide useful scientific information. The Faculty, divided into working groups, analysed the relevant literature. Preliminary statements developed by each group were exhaustively discussed in plenary sessions and approved. Results: Statements were developed to inform clinicians on the identification of secondary forms of calcium nephrolithiasis and systemic complications; on the definition of idiopathic calcium nephrolithiasis; on the use of urinary tests of crystallization and of surgical observations during stone treatment in the management of these patients; on the identification of patients warranting preventive measures; on the role of fluid and nutritional measures and of drugs to prevent recurrent episodes of stones; and finally, on the cooperation between the urologist and nephrologist in the renal stone patients. Conclusions: This document has addressed idiopathic calcium nephrolithiasis from the perspective of a disease that can associate with systemic disorders, emphasizing the interplay needed between urologists and nephrologists. It is complementary to the American Urological Association and European Association of Urology guidelines. Future areas for research are identified

Retroperitoneoscopic urologic surgery : The Way I Do It

Minimal invasive surgery is widely used in urology. Many operations now can be performed by percutaneous, laparoscopic or retroperitoneoscopic routes In my philosophy, retroperitoneoscopic surgery is the best alternative to open surgery for various ablative and reconstructive procedures. While adrenalectomy and nephrectomy can be easily performed by retroperitoneoscopy, stone, surgery is also possible with this technique. It provides a direct access to the urological organs that are situated in the retroperitoneum In this video presentation, my technique of retroperitoneoscopy is presented using only 3 ports The patient is placed in the flank position A one cm incision is made at the subcostal area at the mid-clavicular line After baloon dilation of the retropentoneum is achieved, two other ports are placed Two 10 mm and one 5 mm ports have been enough to perform venous urologic operations retropentoneoscopically. Providing a direct access and the best cosmetic results, retroperitoneoscopic surgery with this technique has been successful in more than 20 operations we had performed in the last 2 years