Jeffrey La Rochelle

Functional and Oncological Outcomes of Partial Nephrectomy of Solitary Kidneys

PURPOSE We examined outcomes after partial nephrectomy in patients with tumors in a solitary kidney to determine the extent to which patient, surgery and tumor specific variables influenced the glomerular filtration rate and local recurrence postoperatively. MATERIALS AND METHODS Demographics, renal function, comorbidities, renal cell carcinoma history, and operative and pathological data were recorded. The effect on changes in early and late postoperative glomerular filtration rate and local recurrence were analyzed. RESULTS In 84 patients undergoing a total of 89 partial nephrectomies the mean immediate postoperative decrease in the glomerular filtration rate in those with no ischemia, warm ischemia (mean 12 minutes) and cold ischemia (mean 33 minutes) was 29%, 37% and 45%, respectively (p <0.01). Late glomerular filtration rate decreases were 12%, 6% and 16%, respectively (p = 0.17). Cold ischemia and multiple vascular risk factors were associated with immediate glomerular filtration rate decreases (p = 0.008 and 0.04, respectively). Local recurrence, which developed in 13 patients (18%), was associated with positive margins and T stage (p = 0.01 and 0.02, respectively). End stage renal disease developed in 3 patients (4%) and an additional 5 (6%) required nephrectomy for local recurrence. CONCLUSIONS Partial nephrectomy generally results in a small decrease in the glomerular filtration rate, and limited warm and cold ischemia does not appear to adversely affect long-term renal function. Positive margins and T stage greater than 2 are the most important predictors of local recurrence in a solitary kidney. They pose a significant risk to end stage renal disease-free survival due to the need for completion nephrectomy in many of these patients. Partial nephrectomy should be considered the standard of care in all patients with tumor in the solitary kidney.

Chromosome 9p deletions identify an aggressive phenotype of clear cell renal cell carcinoma

The authors investigated whether deletion of chromosome 9p in clear cell renal cell carcinoma (ccRCC) predicted worse disease‐specific survival (DSS) and recurrence‐free survival (RFS) and whether it was associated with more aggressive behavior in small renal masses.

Chemoprevention of bladder cancer

Most bladder cancers present at a noninvasive stage and thus do not require radical resection. However, bladder cancer is a polychronotopic disease, and after initial treatment the urothelium remains vulnerable to later recurrences. Effective methods to prevent recurrences would therefore be of great value. The bladder is particularly well suited to the study of chemopreventive strategies designed to reduce the incidence of new tumours. Its anatomical location allows for effective outpatient surveillance using cystoscopy, which can be performed in an office setting, and voided urine can be examined completely non-invasively for the presence of shed malignant cells. Furthermore, the bladder’s function as a storage compartment for urine probably contributes to its susceptibility to malignant transformation due to the presence of concentrated carcinogens. However, this property can be exploited for the purpose of chemoprevention by allowing direct and prolonged exposure to concentrated ‘anticarcinogens’, i.e. substances that counteract the effects of cancer-promoting molecules. Also, populations at high-risk of developing bladder cancer can now be more easily identified, and progress is being made in identifying biomarkers that provide information about disease susceptibility, exposure, risk and treatment response. This makes it easier to study the effectiveness of a particular agent by making it more likely that a statistical difference will be detected if the substance has activity. Identifying high-risk groups also makes the subsequent use of chemopreventive agents more cost-effective.

MP55-10 GASTROINTESTINAL RECOVERY USING PERIOPERATIVE ALVIMOPAN WITH ROBOTIC CYSTECTOMY AND URINARY DIVERSION

tumors. During the median follow up of 55 months, no MIBC recurrence was observed, although 13 (19%) of the 70 patients had non-invasive tumor recurrence. Three patients developed distant metastases and died of cancer at 10, 39, and 87months after PC (5y-BFS,MFS andCSSwere 76%, 100%, and 96%, respectively). Synchronous multifocality was not associated with MIBC recurrence or CSS, while it was marginally associated with non-invasive tumor recurrence (5y-BFS, MFS, CSS were 58%, 100%, 100% in those with synchronous multifocality, vs. 81%, 100%, 95% in those without, p 1⁄4 0.11, 1.00, 0.67, respectively). Metachronous multifocality was not predictive for any of these outcomes. CONCLUSIONS: Bladder-sparing approach might be safely applied to properly selected patients with synchronous or metachronous multifocal tumors, as long as patients meet our PC criteria and undergo consolidative PC.

Evaluation of the Patient With Erectile Dysfunction

Evaluation of the male with erectile dysfunction (ED) has evolved over the past two decades. Although a complex array of diagnostic studies are available and may be employed in the appropriate subject, for the great majority of men these invasive, expensive, and on occasion painful studies are not necessary. Clearly, most men have a physiological etiology to their dysfunction and in fact, most of these men have a vascular cause. It seems that the fundamentals of medicine provide the most useful information, including a thorough medical history and physical exam as well as blood testing of serum glucose, lipids, and, when a hypogonadal etiology is suspected, semen testosterone.