Salvage robot-assisted partial nephrectomy for the management of renal cell carcinoma following failed stereotactic radiotherapy.

Nephron-sparing surgery is currently the standard of care for the management of small renal masses. While both neoadjuvant and adjuvant conventional external beam radiotherapy have failed to demonstrate an oncologic benefit for the treatment of renal cell carcinoma, more recent work aims to explore the utility of stereotactic radiotherapy. We present the case of a 70-year-old woman who failed primary treatment of a small renal mass with the CyberKnife radiotherapy system and describe her successful salvage treatment with robot-assisted partial nephrectomy.

Intravesical methylene blue facilitates precise identification of the diverticular neck during robot-assisted laparoscopic bladder diverticulectomy.

Background: The aim of this report is to describe our surgical technique for robot-assisted laparoscopic bladder diverticulectomy. In this technique, methylene blue is instilled into the bladder to aid in intra-abdominal identification of the diverticular neck.

Subjects And Methods: We retrospectively reviewed the records of patients who underwent robot-assisted bladder diverticulectomy by a single surgeon.

Modified surgical technique for the management of renal cell carcinoma with level I or II tumor thrombus.

Objective: To describe a modified open surgical technique for the resection of renal cell carcinoma with level I or II tumor thrombus.

Method: In our modified technique, the renal artery is ligated early and the tumor thrombus is secured ahead of kidney mobilization by either milking into the renal vein or with extirpation from the inferior vena cava. We retrospectively studied patients who were managed with this technique.

Budd-Chiari syndrome in urology: Impact on nephrectomy for advanced renal cell carcinoma.

Objectives: Budd-Chiari syndrome (BCS) is a poorly understood entity in urology. It results from obstruction of the hepatic veins and the subsequent complications. It has been infrequently reported to be secondary to hepatic venous obstruction from invasion by an inferior vena cava (IVC) tumor thrombus in renal cell carcinoma (RCC).

Molecular characterization of kidney cancer: association of hyaluronic acid family with histological subtypes and metastasis.

Background: Molecular profiling of renal cell carcinomas (RCCs) may improve the distinction between oncocytoma and malignant RCC subtypes and aid in early detection of metastasis. The hyaluronic acid (HA) family includes HA synthases (HAS1, HAS2, HAS3), hyaluronidases (HYAL-1, HYAL-2, HYAL-3, HYAL-4, PH20, HYAL-P1), and HA receptors (CD44s, CD44v, RHAMM). HA family members promote tumor growth and metastasis.

Surgical resection of a virilizing adrenal mass with extensive tumor thrombus.

Adrenocortical carcinoma with tumor thrombus and concomitant testosterone production is a rare entity. We describe a case of a 53-year-old woman with a testosterone producing left-sided adrenocortical carcinoma with tumor extending to the right atrium and tumor embolus to the right pulmonary artery. To our knowledge, there exist no such reported cases in the medical literature.

Liver transplantation techniques for the surgical management of renal cell carcinoma with tumor thrombus in the inferior vena cava: step-by-step description.

Background: Renal cell carcinoma (RCC) with tumor thrombus in the inferior vena cava (IVC) poses a challenge to the surgeon given the operative difficulty, potential for massive hemorrhage, and possibility of tumor thromboemboli.

Objective: To determine the applicability of a self-developed technique based on orthotopic liver transplantation procedures for safe resection of these tumors.

Design, Setting, And Participants: From August 1997 to February 2008, 68 consecutive patients underwent resection of RCC with suprahepatic and/or retrohepatic (level 3 and 4) tumor thrombus in a single referral institution.

Living donor nephrectomy: University of Miami technique and current results.

Objectives: Living-donor nephrectomy has significantly expanded the pool of renal transplant donors, allowing for a marked increase in transplantation. Improvements in antirejection medications and refinement of donor selection criteria have allowed for extremely favorable rates of graft survival. More recently, laparoscopic donor nephrectomy (LDN) has significantly reduced the morbidity of renal transplantation in the donor population.

Antitumor activity of hyaluronic acid synthesis inhibitor 4-methylumbelliferone in prostate cancer cells.

4-Methylumbelliferone (4-MU) is a hyaluronic acid (HA) synthesis inhibitor with anticancer properties; the mechanism of its anticancer effects is unknown. We evaluated the effects of 4-MU on prostate cancer cells. 4-MU inhibited proliferation, motility, and invasion of DU145, PC3-ML, LNCaP, C4-2B, and/or LAPC-4 cells.

Surgical technique of removal of inferior vena cava leiomyosarcoma extending into the right atrium without deep hypothermic circulatory arrest.

Background: Leiomyosarcoma of the inferior vena cava is a rare tumor with potential for significant morbidity and mortality. Surgical extirpiration remains the optimal treatment choice. A case of caval leiomyosarcoma with right atrial extension is presented with management techniques and literature review.

Renal carcinoma with supradiaphragmatic tumor thrombus: avoiding sternotomy and cardiopulmonary bypass.

Background: Renal cell carcinoma with tumor thrombus extension into the inferior vena cava (IVC) is rare. Surgical resection provides the only reasonable chance for cure, but the approach poses a challenge to the surgical team. We describe our technique to safely resect these tumors through a transabdominal incision that exposes the intrapericardial IVC and right atrium (RA) transdiaphragmatically, without the use of sternotomy, cardiopulmonary bypass (CBP), or deep hypothermic circulatory arrest (DHCA).

Novel management of complicated renal artery aneurysm: laparoscopic nephrectomy and ex-vivo repair with heterotopic autotransplant.

Background And Purpose: Renal artery aneurysm (RAA) is an infrequently seen disease entity but one with the potential for significant morbidity and mortality. Complications related to RAA include pain, hematuria, hypertension, and, rarely, rupture. Management is often based on symptomatology or, if symptoms are not present, the potential for rupture with increased size.

Techniques for avoidance of sternotomy and cardiopulmonary bypass during resection of extensive renal cell carcinoma with vena caval tumor thrombus extension above the diaphragm.

Renal cell carcinoma (RCC) is a commonly encountered malignancy in urology. Extensive RCC may frequently invade the renal vein and the inferior vena cava (IVC). In advanced cases, this tumor thrombus may grow cephalad up to the level of the right atrium.

Vascular stapling of the inferior vena cava: further refinement of techniques for the excision of extensive renal cell carcinoma with unresectable vena-caval involvement.

Objectives: To present our experience with a novel technique of tumor removal: en bloc resection of the tumor, thrombus, and inferior vena cava (IVC) via vascular staple ligation and excision, and to excise all tumor, which may include a portion of the IVC when invasion is present. Management of renal cell carcinoma (RCC) with IVC thrombus presents a challenge. Options for tumor excision include thrombectomy with or without cardiopulmonary bypass, replacement of the cava with synthetic or venous graft, or caval excision without replacement.

Potential new urinary markers in the early detection of bladder cancer.

Purpose Of Review: Bladder cancer remains a highly prevalent and lethal malignancy. Early diagnosis and prompt treatment have been shown to improve survival at both initial diagnosis and recurrence. A vast number of tumor markers have been identified and rigorously evaluated in attempts to improve noninvasive diagnostic accuracy of bladder cancer.

The risk and prophylactic management of bladder cancer after various forms of radiotherapy.

Purpose Of Review: Prostate cancer is the most common cancer diagnosed in men and remains the second most lethal malignancy. Most patients undergoing treatment elect for radical prostatectomy or radiation. As the number of patients treated has increased and survival improved, delayed complications of these modalities has assumed increased importance.

Bladder tumor markers: from hematuria to molecular diagnostics--where do we stand?

Bladder cancer is a common malignancy in the USA. Currently, the detection of initial tumors and recurrent disease is based on evaluation of voided urinary specimens, often followed by cystoscopy. With the high rate of recurrence, cystoscopies are regularly repeated with the aim of halting progression of the disease.