Ramzi Jabaji

Survival outcomes after radical and partial nephrectomy for clinical T2 renal tumours categorised by R.E.N.A.L. nephrometry score

We evaluated survival outcomes of partial nephrectomy (PN) and radical nephrectomy (RN) for clinical T2 renal masses (cT2RM) controlling for R.E.N.A.L. nephrometry score.

Impact of tumour morphology on renal function decline after partial nephrectomy

To examine the association of renal morphology with renal function after partial nephrectomy (PN).

Evaluation of national trends in the utilization of partial nephrectomy in relation to the publication of the American Urologic Association guidelines for the management of clinical T1 renal masses.

BackgroundPartial nephrectomy has been underutilized in the United States. We investigated national trends in partial nephrectomy (PN) utilization before and after publication of the American Urological Association (AUA) Practice Guideline for management of the clinical T1 renal mass.MethodsWe identified adult patients who underwent radical (RN) or PN from November 2007 to October 2011 in the Nationwide Inpatient Sample (NIS). PN prevalence was calculated prior to (11/2007-10/2009) and after Guidelines publication (11/2009-10/2011) and compared the rate of change by linear regression. We also examined the nephrectomy trends in patients with chronic kidney disease (CKD). Statistical analysis included linear regression to determine point-prevalence of PN rates in CKD patients and logistic regression to identify variables associated with PN.ResultsDuring the study period, 30,944 patients underwent PN and 64,767 RN. The prevalence PN increased from 28.9% in the years prior to guideline release to 35.3% in the years following guideline release with an adjusted odds ratio (OR) of 1.24 (CI 1.01–1.54; p = 0.049). The rate of PN significantly increased throughout the study period (R2 0.15, p = 0.006): however, the rate of change was not increased after the guidelines. (p = 0.46). Overall rate of PN in patients with CKD did not increase over time (R2 0.0007, p = 0.99).ConclusionWe noted a 6.4% absolute increase in PN after release of the AUA guidelines on clinical T1 renal mass was published; however, the rate of increase was not likely associated with guideline release. The rate of PN performed is increasing; however, further investigation regarding medical decision-making surrounding PN is needed.

Impact of renal surgery for cortical neoplasms on lipid metabolism

To examine the incidence of and risk factors for development of hyperlipidaemia in patients undergoing radical nephrectomy (RN) or partial nephrectomy (PN) for renal cortical neoplasms, as hyperlipidaemia is a major source of morbidity in chronic kidney disease (CKD).

What is the Incidence of Kidney Stones after Chemotherapy in Patients with Lymphoproliferative or Myeloproliferative Disorders

INTRODUCTION This study describes the incidence and risk factors of de novo nephrolithiasis among patients with lymphoproliferative or myeloproliferative diseases who have undergone chemotherapy. MATERIALS AND METHODS From 2001 to 2011, patients with lymphoproliferative or myeloproliferative disorders treated with chemotherapy were retrospectively identified. The incidence of image proven nephrolithiasis after chemotherapy was determined. Demographic and clinical variables were recorded. Patients with a history of nephrolithiasis prior to chemotherapy were excluded. The primary outcome was incidence of nephrolithiasis, and secondary outcomes were risk factors predictive of de novo stone. Comparative statistics were used to compare demographic and disease specific variables for patients who developed de novo stones versus those who did not. RESULTS A total of 1,316 patients were identified and the incidence of de novo nephrolithiasis was 5.5% (72/1316; symptomatic stones 1.8% 24/1316). Among patients with nephrolithiasis, 72.2% had lymphoproliferative disorders, 27.8% had myeloproliferative disorders, and 25% utilized allopurinol. The median urinary pH was 5.5, and the mean serum uric acid, calcium, potassium and phosphorus levels were 7.5, 9.6, 4.3, and 3.8 mg/dL, respectively. In univariate analysis, mean uric acid (p=0.013), calcium (p<0.001)), and potassium (p=0.039) levels were higher in stone formers. Diabetes mellitus (p<0.001), hypertension (p=0.003), and hyperlipidemia (p<0.001) were more common in stone formers. In multivariate analysis, diabetes mellitus, hyperuricemia, and hypercalcemia predicted stone. CONCLUSIONS We report the incidence of de novo nephrolithiasis in patients who have undergone chemotherapy. Diabetes mellitus, hyperuricemia, and hypercalcemia are patient-specific risk factors that increase the odds of developing an upper tract stone following chemotherapy.

Scrotal flap reconstruction for treatment of erectile dysfunction following penile enhancement with liquid silicone

a Institute of Urology, University of Southern California, Keck School of Medicine, Los Angeles, CA, United States Department of Urology, Kaiser Permanente Los Angeles Medical Center, Los Angeles, CA, United States c David Geffen School of Medicine at University of California, Los Angeles, CA, United States d Department of Urology, Kaiser Permanente Downey Medical Center, Downey, CA, United States

Paraneoplastic renal cell carcinoma in the setting of preeclampsia and placental abruption

Paraneoplastic syndromes are systemic disorders in response to a neoplasm and can have various clinical manifestations depending on the organ system(s) affected. Paraneoplastic renal cell carcinoma (RCC) arises from the release of cytokines and hormones from the tumor and can have a variety of presentations including hypertension, hypercalcemia, anemia, fevers, coagulopathy, transaminitis, and polycythemia. Approximately 10–40% of patients with RCC develop a paraneoplastic syndrome of which hypercalcemia and hypertension are among the two most common presenting signs. Paraneoplastic RCC in the perinatal period, however, is exceedingly rare. Here, we illustrate a novel clinical scenario of paraneoplastic RCC presenting in a previously healthy 20 year old postpartum patient whose pregnancy was complicated by preeclampsia and placental abruption.

Robotic partial cystectomy for venous malformation of the bladder

Congenital vascular malformations of the urinary tract are uncommon. They may consist of venous, arterial, and/or lymphatic components. Hemangiomas, which have an arterial component, are the most common type of vascular malformation, yet still represent only 0.6% of all bladder lesions; venous malformations (VMs) are even rarer. Patients typically present with gross hematuria, although suprapubic pain and lower urinary tract symptoms have also been described. Treatment of vascular malformations of the bladder ranges from endoscopic fulguration to excision depending on the extent of the disease. While open surgical treatment has been previously described, robotic partial cystectomy for VM of the bladder is a rare procedure. This report describes an unusual case in a teenager.

MP55-20 ADOPTION OF ROBOTIC PARTIAL NEPHRECTOMY: ITS EFFECT ON RENAL CANCER SURGERY AND KAISER PERMANENTE SOUTHERN CALIFORNIA PRACTICE PATTERNS

differ among groups (P 1⁄4 0.5), but overall survival was lower in the AS group (65.9%, P 1⁄4 0.01) compared to PN (91.9%), RN (89.6%), and ablation (82.9%). From 193 patients, median GFR at enrollment was similar at 71.3, 68.1, 55.5, and 69.5 mL/min/1.73 m in the PN, RN, ablation, and AS groups, respectively (P 1⁄4 0.7); at a median follow-up time of 1.5 years, the median GFR was 69.3, 43.7, 55.7, and 68.0 mL/ min/1.73 m across the respective groups (P 1⁄4 0.2). From a total of 1,932 SF-12 questionnaires, PN patients reported significantly higher PCS scores compared to AS patients at enrollment and annually thereafter until year 5. Patients in AS demonstrated lower PCS scores over time (P 1⁄4 0.01), but MCS was not meaningfully different among groups or across time. CONCLUSIONS: Superior overall survival and PCS outcomes in PN patients compared to AS patients are attributable to more favorable health characteristics at baseline. However, kidney function at enrollment was not a factor in determining management and does not vary appreciably after intervention type.

PD16-05 COMPUTER ASSISTED RENAL VOLUMETRIC ASSESSMENT TO PREDICT POSTOPERATIVE RENAL FUNCTION PRIOR TO EXTIRPATIVE RENAL SURGERY

INTRODUCTION AND OBJECTIVES: To incorporate a computer-assisted volumetric assessement of potential spared paranchyma from preoperative CT scans to predict chronic kidney disease (CKD) at 6 months from extirpative renal surgery. METHODS: We performed a retrospecitve analysis of radical (RN) or partial nephrectomy (PN) patients with compatable CT scans from our institution. We used Vitrea v.6.3 computer software program (Vital Images, Minnetonka, MN) to create a 3D volume of the tumor, 1 cm margin, ipsilateral kidney (Figure), and contralateral kidney (cm3). Primary outcome analyzed was development of postoperative CKD (estimated glomerular filtration rate<60 mL/min/ 1.73 m2 by MDRD equation). We performed linear regression using preoperative GFR, total RENAL nephrometry score, and volumes (excluding tumor) to predict 6-month GFR and tested with 5-fold cross validation. The GFR generated by our analysis was compared to postoperative eGFR for prediction of CKD to calculate test characteristics [sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV)] and area under the curve (AUC). RESULTS: We included 130 patients (79 PN/51 RN) from our database from 3/2000 to 2/2013 and a median eGFR follow-up of 6.1 (4.2-36) months. Median age was 58 (IQR: 49-67), 83 (61%) men, and 53 (57%) Caucasian. Median tumor volume was 24.6 (IQR: 7e82) cm3. The most signifant corrlates of post operative renal function were preoperative eGFR (p<0.001), Isipateral volume (p<0.001), and estimated margin volume (p<0.001). RENAL nephromery score (p1⁄40.285) and contralateral renal volume (p1⁄40.418) were non-signficant. In multivariate linear regression, the predicted GFR correlated with postoperative GFR at 6 months (R21⁄40.518, p<0.001). Using the model, prediction of postoperative CKD noted an AUC of 0.752 (95% CI 0.662-0.842; p1⁄4<0.001) with accompanying sensitivity (86.7%), specificity (63.6%), positive predicitve value (76.5%), and negative predictive value (77.8%). CONCLUSIONS: Preoperative GFR and computer assisted predicted renal volume spared are able to predict 6-month postoperative occurance of CKD. While prospective validation is requisite, this technique may provide valuable information regarding risk of postoperative CKD in clincial decision-making regarding partial or radical nephrectomy and post-operative expectations.