Christopher J. DiBlasio

Comparison of rates and risk factors for developing chronic renal insufficiency, proteinuria and metabolic acidosis after radical or partial nephrectomy

To investigate the incidence of and risk factors for developing chronic renal insufficiency (CRI), proteinuria and metabolic acidosis (MA) in patients treated with radical nephrectomy (RN) or nephron‐sparing surgery (NSS).

Risk of new-onset diabetes mellitus and worsening glycaemic variables for established diabetes in men undergoing androgen-deprivation therapy for prostate cancer

To investigate the incidence of new‐onset diabetes mellitus (NODM) and of worsening glycaemic control in established DM after starting androgen‐deprivation therapy (ADT) for prostate cancer, as ADT is associated with altered body composition, potentially influencing insulin sensitivity.

Feasibility and efficacy of neoadjuvant sunitinib before nephron-sparing surgery.

Study type – Therapy (case series)
Level of Evidence 4

Patterns of sexual and erectile dysfunction and response to treatment in patients receiving androgen deprivation therapy for prostate cancer

To investigate the incidence of patient‐reported erectile (ED) and sexual dysfunction and response to treatment in men after the induction of androgen deprivation therapy (ADT) for prostate cancer, as ADT‐induced changes in serum testosterone can result in changes in libido and sexual function.

Nonoperative management of blunt renal trauma: is routine early follow-up imaging necessary?

BackgroundThere is no consensus on the role of routine follow-up imaging during nonoperative management of blunt renal trauma. We reviewed our experience with nonoperative management of blunt renal injuries in order to evaluate the utility of routine early follow-up imaging.MethodsWe reviewed all cases of blunt renal injury admitted for nonoperative management at our institution between 1/2002 and 1/2006. Data were compiled from chart review, and clinical outcomes were correlated with CT imaging results.Results207 patients were identified (210 renal units). American Association for the Surgery of Trauma (AAST) grades I, II, III, IV, and V were assigned to 35 (16%), 66 (31%), 81 (39%), 26 (13%), and 2 (1%) renal units, respectively. 177 (84%) renal units underwent routine follow-up imaging 24–48 hours after admission. In three cases of grade IV renal injury, a ureteral stent was placed after serial imaging demonstrated persistent extravasation. In no other cases did follow-up imaging independently alter clinical management. There were no urologic complications among cases for which follow-up imaging was not obtained.ConclusionRoutine follow-up imaging is unnecessary for blunt renal injuries of grades I-III. Grade IV renovascular injuries can be followed clinically without routine early follow-up imaging, but urine extravasation necessitates serial imaging to guide management decisions. The volume of grade V renal injuries in this study is not sufficient to support or contest the need for routine follow-up imaging.

Single center comparison of laparoscopic cryoablation and CT-guided percutaneous cryoablation for renal tumors

BACKGROUND AND PURPOSE Cryoablation has demonstrated therapeutic effectiveness for selected renal tumors. We compared our perioperative and short-term outcomes of laparoscopic (LAP) v percutaneous (PERC) renal cryoablation. PATIENTS AND METHODS Thirty-four patients (18 men/16 women) underwent a LAP and 26 patients (19 men/7 women) underwent a PERC procedure between September1998 and January 2007. LAP cryoablation was performed transperitoneally with ultrasonographic monitoring. PERC cryoablation was performed with CT guidance. Follow-up imaging was obtained at regular intervals. RESULTS Mean follow-up was 25 months. Average age (years) was 67.0 for the LAP and 69.7 for the PERC procedure (P = 0.307). Mean body mass index (kg/m(2)) was 29.8 for those undergoing LAP and 28.7 for those undergoing PERC procedures (P = 0.543). Mean tumor size (cm) was 2.9 for LAP patients and 3.1 for PERC patients (P = 0.432). Anterior tumors comprised 61.7% of LAP and 15.4% of PERC procedures (P < 0.001). Posterior tumors comprised 32.4% of LAP and 65.4% of PERC procedures (P = 0.01). Mean procedure time (minutes) was 165.7 for LAP and 106.6 for PERC procedures (P < 0.001). Hospital stay (days) was 2.6 for those undergoing LAP and 1.8 for those undergoing PERC procedures (P < 0.001). Both LAP patients (82.4%) and PERC patients (19.2%) needed postoperative narcotics (P < 0.001). Atelectasis developed in 70.6% of LAP patients and 34.6% of PERC patients (P = 0.005). Residual enhancement was seen in 11.5% of PERC patients and 2.9% of LAP patients (P = 0.192). Complications developed in 14.7% of LAP patients and 26.9% of PERC patients (P = 0.248). 1-year, 2-year, and 3-year disease-specific survival for the two groups was 100%. Tumor size > 4 cm and endophytic location were significantly associated with residual enhancement. CONCLUSIONS LAP and PERC renal cryoablation have similar short-term outcomes. Significantly more anterior tumors were approached laparoscopically and significantly more posterior tumors were approached percutaneously. The PERC approach may offer advantages regarding hospital stay, narcotic need, and development of atelectasis. Longer-term data are needed to establish success of this approach.

Sutureless laparoscopic heminephrectomy: safety and efficacy in physiologic and chronically obstructed porcine kidney.

We sought to develop and examine the feasibility and efficacy of a streamlined sutureless system of repairing parenchymal and collecting system defects using BioGlue (bovine albumin-glutaraldehyde adhesive) and ProPatch (bovine pericardial patch) in swine under physiological conditions and mechanical stress imposed by chronic ureteral obstruction caused by complete ureteral transaction. Five pigs (10 kidneys) underwent left-side transperitoneal laparoscopic heminephrectomy, followed 2 weeks later by right-sided heminephrectomy with complete ureteral transaction (between clips) to provide a mechanical stressor on the repair, followed 2 weeks later by euthanasia. In each case, after hilar clamping, the lower pole was removed with a bipolar dissector. Hemostasis was obtained with argon beam coagulator and FloSeal (thrombin-gelatin matrix), followed by sutureless repair (ProPatch-BioGlue “sandwich”). At euthanasia, harvested kidneys underwent ex vivo retrograde-pyelography and pathological examination to rule out urinoma/perinephric fluid collection and determine collecting system/parenchymal healing. Mean operative time was 77.8 minutes. Mean warm ischemia time was 12.3 ± 5.6 minutes. Estimated blood loss was 49.5 ± 39.0 mL. All animals demonstrated immediate hemostasis on hilar clamp release. Pyelography failed to demonstrate any collecting system leakage, and closure and healing was confirmed in all. Four of 5 pigs had intact renal function at euthanasia. Two pigs were euthanized for causes unrelated to procedures 4 days prior to study end. This study provides proof of principle that sutureless laparoscopic heminephrectomy is effective in physiological and chronic obstruction conditions in the porcine model. The procedure is reproducible, and resection/renorrhaphy was completed on average with approximately 12 minutes warm ischemia time.

Contemporary analysis of erectile, voiding, and oncologic outcomes following primary targeted cryoablation of the prostate for clinically localized prostate cancer.

PURPOSE To evaluate erectile function (EF) and voiding function following primary targeted cryoablation of the prostate (TCAP) for clinically localized prostate cancer (CaP) in a contemporary cohort. MATERIALS AND METHODS We retrospectively reviewed all patients treated between 2/2000-5/2006 with primary TCAP. Variables included age, Gleason sum, pre-TCAP prostate specific antigen (PSA), prostate volume, clinical stage, pre-TCAP hormonal ablation, pre-TCAP EF and American Urologic Association Symptom Score (AUASS). EF was recorded as follows: 1 = potent; 2 = sufficient for intercourse; 3 = partial/insufficient; 4 = minimal/insufficient; 5 = none. Voiding function was analyzed by comparing pre/post-TCAP AUASS. Statistical analysis utilized SAS software with p < 0.05 considered significant. RESULTS After exclusions, 78 consecutive patients were analyzed with a mean age of 69.2 years and follow-up 39.8 months. Thirty-five (44.9%) men reported pre-TCAP EF level of 1-2. Post-TCAP, 9 of 35 (25.7%) regained EF of level 1-2 while 1 (2.9%) achieved level 3 EF. Median pre-TCAP AUASS was 8.75 versus 7.50 postoperatively (p = 0.39). Six patients (7.7%) experienced post-TCAP urinary incontinence. Lower pre-TCAP PSA (p = 0.008) and higher Gleason sum (p = 0.002) were associated with higher post-TCAP AUASS while prostate volume demonstrated a trend (p = 0.07). Post-TCAP EF and stable AUASS were not associated with increased disease-recurrence (p = 0.24 and p = 0.67, respectively). CONCLUSIONS Stable voiding function was observed post-TCAP, with an overall incontinence rate of 7.7%. Further, though erectile dysfunction is common following TCAP, 25.7% of previously potent patients demonstrated erections suitable for intercourse. While long-term data is requisite, consideration should be made for prospective evaluation of penile rehabilitation following primary TCAP.

Variation in the incidence of and risk factors for the development of nephrolithiasis after radical or partial nephrectomy

Study Type – Prevalence (retrospective cohort)
Level of Evidence 2b

EVALUATION OF URINARY NUCLEAR MATRIX PROTEIN 22 TEST FOR DETECTION OF UPPER TRACT UROTHELIAL CARCINOMA

(87.2%, 74.4%) compared to the HAS1-HYAL1 (78.7%, 73.2%), HAS3HYAL1 (80.5%, 68.3%), HAS1-HAS2 (83%, 64.6%) and HAS2-HAS3 (85.1%, 67%) combinations. The HAS2-HYAL1 combination exhibited high sensitivity in detecting low(85.7%) and high-(87.8%) grade tumors. Five patients with a history of bladder cancer recurred within 6 months and 4 of them were positive for the HAS2HYAL1 and HAS2-HYAL1 combinations. CONCLUSIONS: A real time RT-PCR based assay for HYAL1 and HAS mRNA measurement detects bladder cancer with high