Alistair Rogers

The management of transitional cell carcinoma (TCC) in a European regional renal transplant population.

Study Type – Therapy (prospective cohort)

Management of secondary pelviureteric junction obstruction

Pelviureteric junction obstruction (PUJO) of the kidney can lead to a number of different clinical manifestations, which often require surgical intervention. Although the success of pyeloplasty and endopyelotomy are good, there are still a number of patients who fail primary treatment and develop secondary PUJO. These treatment failures can be a challenging cohort to manage. This article aims to provide a comprehensive overview on the surgical options available to the urologist for managing secondary PUJO as well as providing some guidance on assessing factors that will influence management decisions.

Renal Cell Cancer in a European Regional Renal Transplant Population: Is There a Role for Immediate Native Renal Radiological Surveillance Before and After Transplantation?

BACKGROUND The risk of the development of renal cell cancer (RCC) in renal transplant recipients is several times higher than the general population. There can often be a delay between initial radiological imaging and patients undergoing renal transplantation. We present and evaluate the prevalence and clinical characteristics of RCC in renal transplant recipients at a single UK transplant center, with particular focus on tumors diagnosed in the immediate post-operative period, that is, likely present before transplantation. METHODS This is a retrospective cohort study examining all renal transplant recipients with the diagnosis of RCC of native and/or graft kidneys followed up in a single UK transplant center. RESULTS Between January 2002 and April 2014, 1386 patients underwent renal transplantation. 19 of 1386 patients had development of RCC (1.4%): 17 native and 2 graft tumors. The mean interval between pre-operative native renal imaging and transplantation was 3.5 years in 13 of 19 patients (range, 1-10 years). Six patients had no documented renal imaging before their renal transplant. The median time from transplantation to diagnosis of RCC was 5 years (range, 1 month to 30 years). In 5 patients (26.3%), RSS developed within 6 months of undergoing renal transplantation. CONCLUSIONS In our study, we identified several patients with RCC diagnosed shortly after surgery, which raised the possibility that this was present before transplantation. With transplant recipients at increased risk of development of RCC and early detection key in the management of RCC, there appears to be a role for native renal radiological screening for patients undergoing renal transplantation.

Expression of the tumour antigen T21 is up-regulated in prostate cancer and is associated with tumour stage

Whats known on the subject? and What does the study add?

Incidental metastatic endocrine tumor diagnosed at laparoscopic radical prostatectomy and bilateral lymph node dissection

The introduction and expansion of laparoscopic and robotic radical retropubic prostatectomy (LRRP and RRRP) for organ-confined prostate cancer have led to an increase in pelvic lymphadenectomy specimens. Extended lymph node dissection (eLND) involves removing nodes over the obturator fossa, external ileac vessels as well as the internal iliac and increases the number of nodes examined. This has the potential to increase incidental nonprostatic nodal pathology identified in prostatectomy specimens. For the first time in the current literature we report the incidental diagnosis of a metastatic small bowel endocrine tumor in a 69-year-old gentleman, made at the time of LRRP and bilateral lymph node dissection. This report suggests that the benefit of an extended lymph node dissection is not only to prostate cancer control and staging, but also to the possibility of diagnosing potentially treatable incidental disease. It is a possibility that both pathologists and urologists alike should be aware of.

Innovative use of a Hawkins III breast localization hookwire in preoperative computed tomography‐guided localization of renal bed tumour recurrence

Loco-regional recurrence of renal tumours after surgical excision is uncommon but can pose several difficulties in management. Improved imaging in the follow-up of patients after nephrectomy has inevitably detected smaller regional recurrences in asymptomatic patients. Local recurrence of RCC at the site of a previous nephrectomy responds poorly to both systemic therapy and radiotherapy. The same is true of the rare carcinoid tumour of the kidney, which is the case presented here. One treatment option is re-excision of the renal bed recurrence, which has been shown to prolong survival [1]. Fibrosis secondary to the initial nephrectomy can make complete re-excision of the tumour bulk, with clear histological margins, difficult [2]. Advances in interventional radiology have aided the surgeon in tumour excision. Preoperative localization of a tumour using a wire was first described for breast lesions [3]. Using a variety of imaging techniques it has also been used for lung nodules, musculoskeletal tumours, tissue scar neuromas, hepatic and intraperitoneal lesions [4–7]. We describe the innovative use of a Hawkins III breast localization needle (Medical Device Technologies, Gainesville, FL, USA) for renal bed tumour recurrence, which to the best of our knowledge, has not previously been described.