Jonah Marshall

Near Infrared Fluorescence Imaging After Intravenous Indocyanine Green: Initial Clinical Experience With Open Partial Nephrectomy for Renal Cortical Tumors

OBJECTIVE To evaluate the safety of near infrared fluorescence (NIRF) of intravenously injected indocyanine green (ICG) during open partial nephrectomy, and to demonstrate the feasibility of this technology to identify the renal vasculature and distinguish renal cortical tumors from normal parenchyma. METHODS Patients undergoing open partial nephrectomy provided written informed consent for inclusion in this institutional review board-approved study. Perirenal fat was removed to allow visualization of the renal parenchyma and lesions to be excised. The patients received intravenous injections of ICG, and NIRF imaging was performed using the SPY system. Intraoperative NIRF video images were evaluated for differentiation of tumor from normal parenchyma and for renal vasculature identification. RESULTS A total of 15 patients underwent 16 open partial nephrectomies. The mean cold ischemia time was 26.6 minutes (range 20-33). All 14 malignant lesions were afluorescent or hypofluorescent compared with the surrounding normal renal parenchyma. NIRF imaging of intravenously injected ICG clearly identified the renal hilar vessels and guided selective arterial clamping in 3 patients. No adverse reactions to ICG were noted, and all surgical margins were negative on final pathologic examination. CONCLUSION The intravenous use of ICG combined with NIRF is safe during open renal surgery. This technology allows the surgeon to distinguish renal cortical tumors from normal tissue and highlights the renal vasculature, with the potential to maximize oncologic control and nephron sparing during open partial nephrectomy. Additional study is needed to determine whether this imaging technique will help improve the outcomes during open partial nephrectomy.

BILITRANSLOCASE (BTL) IS IMMUNOLOCALISED IN PROXIMAL AND DISTAL RENAL TUBULES AND ABSENT IN RENAL CORTICAL TUMORS ACCURATELY CORRESPONDING TO INTRAOPERATIVE NEAR INFRARED FLUORESCENCE (NIRF) EXPRESSION OF RENAL CORTICAL TUMORS USING INTRAVENOUS INDOCYANINE GREEN (ICG)

386 BILITRANSLOCASE (BTL) IS IMMUNOLOCALISED IN PROXIMAL AND DISTAL RENAL TUBULES AND ABSENT IN RENAL CORTICAL TUMORS ACCURATELY CORRESPONDING TO INTRAOPERATIVE NEAR INFRARED FLUORESCENCE (NIRF) EXPRESSION OF RENAL CORTICAL TUMORS USING INTRAVENOUS INDOCYANINE GREEN (ICG) Dragan J Golijanin*, Jonah Marshall, Allison Cardin, Eric A Singer, Ronald W Wood, Jay E Reeder, Guan Wu, Jorge L Yao, Sabina Passamonti, Edward M Messing. Rochester, NY, and Trieste, Italy. INTRODUCTION AND OBJECTIVE: BTL is a 38 kDa

Antopol-Goldman Lesion of the Kidney Diagnosed by Radiology : A Case Report of Observation

Antopol-Goldman lesions are extremely rare and are characterized by subepithelial hematoma in the renal pelvis. There have been at least 28 case reports in the literature, with all being diagnosed histologically after partial or total nephrectomy for a presumed malignancy. We report the first case in the literature to be diagnosed by radiological imaging and followed on an observatory basis.

Inflammatory pseudotumor of the kidney.

An inflammatory pseudotumor (IPT) is a rare entity that was originally described in the lung. 1 Inflammatory pseudotumors have been referred to as inflammatory myofibroblastic tumors, inflammatory pseudosarcomas or pseudosarcomatous myofibroblastic tumors, and atypical fibromyxoid tumors, among others. 2 Extrapulmonary IPTs have also been reported. The most common location in the genitourinary tract is the bladder. 3 A small number of case reports describe IPTs arising from the renal pelvis, the ureter, and, less commonly, the renal parenchyma. An IPT is a benign tumor that is often confused with malignancy. It is composed of spindle cells mixed with variable amounts of lymphocytes, plasma cells, proliferating myofibroblasts, and extracellular collagen. 4,5 Surgical resection is usually required for definitive diagnosis. Although early descriptions of this tumor described it as a reaction to an inflammatory and possibly infectious process, 4,6 the true pathogenesis of IPTs remains unclear. This report documents the course of the disease by imaging from presentation to complete resolution, without surgical resection.

Lost and Now Found: Retained Straight Catheter for 20 Years

A literature review of PubMed reveals that 1 case report is found of a retained Foley catheter for 3 years. We report a case of a straight catheter lost in the urethra and forgotten for 20 years and its safe surgical removal. The calcified straight catheter was removed through a perineal urethrostomy and incision at the meatus and fossa navicularis. A Foley catheter was inserted easily into the urethra for drainage. At last follow-up, 7 weeks after surgery, the patient was voiding successfully without any difficulties.

LAPAROSCOPIC PELVIC LYMPHADENECTOMY WITH REAL TIME LYMPHATIC IMAGING USING NEAR INFRARED FLUORESCENCE (NIRF) CAMERAS

INTRODUCTION AND OBJECTIVE: Androgen ablation (AA) continues to be first line therapy for the treatment of metastatic prostate cancer (CaP). In the last decade, several recommendations have been made to modify AA therapy including the use of combinations of a GnRH agonist with an androgen receptor blocker (ARB) and the introduction of intermittent therapy. Yet it is unclear to what degree urologists have adopted these practices. To address this issue, we performed a survey of members of the Society of Urologic Oncology (SUO) to assess contemporary approaches in the use of AA in patients with metastatic CaP. METHODS: We sent surveys to 170 members of the SUO and received responses from nearly 50% after two rounds of inquiry. The concepts that were addressed included: use of complete simultaneous complete androgen blockade versus sequential blockade, use of intermittent therapy, PSA thresholds for initial therapy and for restarting therapy. RESULTS: The average time from the completion of the residency training was 15.8 years with 72% being fellowship-trained in oncology. The presence of metastasis and PSA doubling time were the most important factors in deciding on the initiation of AA. When primary treatment failed, doubling time less than 6 months was the most common threshold to start AA (66.7%). The use of PSA absolute value after failure primary treatment for starting AA varied significantly with cut-off numbers ranging between 0.4 and 100 ng/dl (median 10 ng/dl). The use of intermittent AA was noted in 84.8% of the questionnaires and was primarily motivated by a perception of improved quality of life in the patients (62.4%) rather than improved cancer-specific outcome (11.9%). ARBs are frequently used for an initial period 2 weeks upon starting GnRH agonists (64.6%) and added on if PSA started to rise while on GnRH agonist in 88.1%. Only, 15.6% of urologists utilize continuous combined androgen blockade mostly in settings of metastasis and high Gleason grades. Practice setting, fellowship training, and years out from training had no impact on responses. CONCLUSIONS: While sustained use of combined GnRH agonist and androgen receptor blocker was wildly herald a decade ago, sequential blockade is currently the preferred approach by most urologists for the treatment of metastatic CaP. Intermittent AA is a popular approach but its therapeutic value over continuous therapy remains to be determined. Threshold PSA values for initiation of therapy are highly variable and should be subjected to further study.

Penile Schwannoma Sonographic Features

Benign and malignant tumors of the penis are uncommon. Benign lesions include leiomyoma, neurofibroma, condyloma acuminatum, schwannoma, bowenoid papulosis, lichen sclerosus, and Peyronie disease. 1-10 Most penile carcinomas are squamous cell. 11 They are located predominantly along the shaft, as opposed to benign lesions, which tend to occur near the glans penis.12 There are a number of case reports of penile schwannoma, but only a few describe the sonographic characteristics of lesions involving the penis. It is important to be familiar with the imaging features of penile tumors to assist in narrowing the differential diagnosis and in planning for potential elective surgery.