Parenchymal obliteration by renal masses: Functional and oncologic implications.

Objectives: Most renal tumors merely displace nephrons while others can obliterate parenchyma in an invasive manner. Substantial parenchymal volume replacement (PVR) by renal cell carcinoma (RCC) may have oncologic implications; however, studies regarding PVR remain limited. Our objective was to evaluate the oncologic implications associated with PVR using improved methodology including more accurate and objective tools.

Holmium Laser Enucleation of the Prostate vs Transvesical Single-port Robotic Simple Prostatectomy for Large Prostatic Glands.

Objective: To compare the perioperative outcomes of transvesical single-port robotic simple prostatectomy (SP-RASP) and holmium laser enucleation of the prostate (HoLEP).

Materials And Methods: A retrospective review was performed of patients undergoing SP-RASP and HoLEP from 2019 to 2022 with preoperative prostatic volume (PPV) >80 cm. Percent of prostate adenoma removed (%PAR) was estimated by specimen weight normalized by PPV.

A Novel Metric for Hospital Quality in Kidney Cancer Surgery: A Veterans Affairs National Health System Validation of Concept.

Introduction: We aimed to develop and validate a Compound Quality Score (CQS) as a metric for hospital-level quality of surgical care in kidney cancer at the Veterans Affairs National Health System.

Methods: A retrospective review of 8,965 patients with kidney cancer treated at Veterans Affairs (2005-2015) was performed. Two previously validated process quality indicators (QIs) were explored: the proportion of patients with 1) T1a tumors undergoing partial nephrectomy and 2) T1-T2 tumors undergoing minimally invasive radical nephrectomy.

Comprehensive Management of Renal Masses in Solitary Kidneys.

Background: A renal mass in a solitary kidney (RMSK) has traditionally been managed with partial nephrectomy (PN), although radical nephrectomy (RN) is occasionally required. Most RMSK studies have focused on patients for whom PN was achieved.

Objective: To provide a comprehensive analysis of the management strategies/outcomes for an RMSK and address knowledge deficits regarding this challenging disorder.

Split Renal Function Is Fundamentally Important for Predicting Functional Recovery After Radical Nephrectomy.

Unlabelled: While partial nephrectomy (PN) is generally preferred for localized renal cell carcinoma (RCC), radical nephrectomy (RN) is occasionally required. A new-baseline glomerular filtration rate (NBGFR) >45 ml/min/1.73 m after kidney cancer surgery is associated with strong survival outcomes.

Pathologic Findings and Management of Renal Mass in Horseshoe Kidneys.

Objectives: To evaluate the management, surgical outcomes, and pathological findings in patients with tumor in a horseshoe-kidney (HK). HK patients present unique challenges due to aberrant vascular anatomy and risk of renal insufficiency. We hypothesized that many tumors in this setting may be indolent or benign.

What Happens to the Preserved Renal Parenchyma After Clamped Partial Nephrectomy?

Background: Most partial nephrectomies (PNs) are performed with hilar occlusion to reduce blood loss and optimize visualization. However, the histologic status of the preserved renal parenchyma years after PN is unknown.

Objective: To compare the histologic chronic kidney disease (CKD) score of renal parenchyma before and years after PN, and to explore factors associated with CKD-score increase and glomerular filtration rate (GFR) decline.

Parenchymal Volume Replacement by Renal Cell Carcinoma Prior to Intervention: Predictive Factors and Functional Implications.

Objective: To analyze predictors, extent and functional implications associated with renal parenchymal volume replacement (PVR) by renal cell carcinoma (RCC) prior to intervention. This phenomenon is well-recognized yet not adequately studied, and, if severe, can influence management.

Materials And Methods: A retrospective review was performed of partial nephrectomy (PN) and radical nephrectomy (RN) patients with available preoperative nuclear-renal-scan and imaging demonstrating solitary RCC with normal contralateral kidney.

Does Reduced Renal Function Predispose to Cancer-specific Mortality from Renal Cell Carcinoma?

Background: Recent publications have reported an association between increased renal cancer-specific mortality (CSM) and reduced renal function "below safety limits," and advocated for partial nephrectomy (PN) even for potentially aggressive/complex tumors. We hypothesize that this association may be related to confounding factors rather than a consequence of functional differences.

Objective: To assess whether there is an independent association between preoperative estimated glomerular filtration rate (eGFR) or new baseline eGFR (NB-GFR) and CSM in patients undergoing PN or radical nephrectomy (RN).

Partial Nephrectomy for Patients with Severe Chronic Kidney Disease-Is It Worthwhile?

Purpose: Partial nephrectomy is prioritized over radical nephrectomy in patients with chronic kidney disease whenever feasible. However, we hypothesized that some patients with severe chronic kidney disease might rapidly progress to end stage renal disease, in which case the morbidity that can be associated with partial nephrectomy would not be justified.

Materials And Methods: A retrospective review of all 62 patients with stage IV chronic kidney disease undergoing partial nephrectomy at our institution (1999-2015) was performed.

Compensatory Changes in Parenchymal Mass and Function after Radical Nephrectomy.

Purpose: Loss of renal function remains a major limitation of radical nephrectomy. The extent of renal functional compensation by the preserved kidney after radical nephrectomy has not been adequately studied in this elderly population with comorbidities.

Materials And Methods: A total of 273 patients treated with radical nephrectomy without end stage renal disease with available preoperative nuclear renal scans were included in the analysis.

Split renal function in patients with renal masses: utility of parenchymal volume analysis vs nuclear renal scans.

Objectives: To evaluate the utility of parenchymal volume analysis (PVA) for estimation of split renal function (SRF) in patients with renal masses. SRF is important for deciding about partial vs radical nephrectomy (PN/RN) and assessing risk for developing severe chronic kidney disease after surgery. For renal donors PVA is routinely used to estimate SRF, but the utility of PVA for the more complex renal mass population remains undefined.

Can We Predict Functional Outcomes after Partial Nephrectomy?

Purpose: The percent of preserved parenchymal mass is the primary determinant of functional outcomes after partial nephrectomy. Accurate methods to predict the percent of preserved parenchymal mass based on preoperative imaging could facilitate patient counseling.

Materials And Methods: We evaluated the records of 428 patients who had undergone partial nephrectomy and the studies necessary to assess preserved ipsilateral parenchymal mass and function.

Open partial nephrectomy when a non-flank approach is required: indications and outcomes.

Purpose: To evaluate indications/outcomes for open partial nephrectomy (OPN) when non-flank approaches are required, with comparison to patients managed with the flank approach. Outcomes with a non-flank approach are presumed less favorable yet there have been no previous reports on this topic.

Methods: 2747 OPNs were performed (1999-2015) and 76 (2.

Acute Kidney Injury after Partial Nephrectomy of Solitary Kidneys: Impact on Long-Term Stability of Renal Function.

Purpose: Acute kidney injury often leads to chronic kidney disease in the general population. The long-term functional impact of acute kidney injury observed after partial nephrectomy has not been adequately studied.

Materials And Methods: From 2004 to 2014 necessary studies for analysis were available for 90 solitary kidneys managed by partial nephrectomy.

Predictors of Long-Term Survival after Renal Cancer Surgery.

Purpose: Renal cancer surgery can adversely impact long-term function and survival. We evaluated predictors of chronic kidney disease 5 years and nonrenal cancer mortality 10 years after renal cancer surgery.

Materials And Methods: We analyzed the records of 4,283 patients who underwent renal cancer surgery from 1997 to 2008.

Functional Comparison of Renal Tumor Enucleation Versus Standard Partial Nephrectomy.

Background: Tumor enucleation (TE) optimizes parenchymal preservation and could yield better function than standard partial nephrectomy (SPN), although data on this are conflicting.

Objective: To compare functional outcomes for TE and SPN strategies.

Design, Setting, And Participants: Patients managed with partial nephrectomy (PN) with necessary data for analysis of preservation of ipsilateral parenchymal mass (IPM) and global glomerular filtration rate (GFR) from two centers were included.