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Transrectal ultrasound-guided needle biopsy of the prostate is routinely performed to diagnose prostate cancer. We performed a prospective study to assess the pain and identify risk factors of pain during prostate biopsy. Prospectively, 131 patients were enrolled. Transrectal ultrasound-guided needle prostate biopsies were performed without any anesthesia. Pain was assessed by using an immediate postbiopsy anonymous questionnaire including a linear visual analog scale (VAS). Six factors were studied (age, prostate volume, cores number, operator, previous biopsy and first core location). Most of the patients tolerated the biopsy with acceptable discomfort. Among the risk factors studied, only first core location influenced the pain. Apex biopsy first was more painful. We recommend starting biopsy with the base.Prostate Cancer and Prostatic Diseases (2003) 6, 239-241. doi:10.1038/sj.pcan.4500664 [ABSTRACT FROM AUTHOR]

BACKGROUND: Cytoreductive nephrectomy has been the standard of care in metastatic renal-cell carcinoma for 20 years, supported by randomized trials and large, retrospective studies. However, the efficacy of targeted therapies has challenged this standard. We assessed the role of nephrectomy in patients with metastatic renal-cell carcinoma who were receiving targeted therapies. METHODS: In this phase 3 trial, we randomly assigned, in a 1:1 ratio, patients with confirmed metastatic clear-cell renal-cell carcinoma at presentation who were suitable candidates for nephrectomy to undergo nephrectomy and then receive sunitinib (standard therapy) or to receive sunitinib alone. Randomization was stratified according to prognostic risk (intermediate or poor) in the Memorial Sloan Kettering Cancer Center prognostic model. Patients received sunitinib at a dose of 50 mg daily in cycles of 28 days on and 14 days off every 6 weeks. The primary end point was overall survival. RESULTS: A total of 450 patients were enrolled from September 2009 to September 2017. At this planned interim analysis, the median follow-up was 50.9 months, with 326 deaths observed. The results in the sunitinib-alone group were noninferior to those in the nephrectomy-sunitinib group with regard to overall survival (stratified hazard ratio for death, 0.89; 95% confidence interval, 0.71 to 1.10; upper boundary of the 95% confidence interval for noninferiority, =1.20). The median overall survival was 18.4 months in the sunitinib-alone group and 13.9 months in the nephrectomy-sunitinib group. No significant differences in response rate or progression-free survival were observed. Adverse events were as anticipated in each group. CONCLUSIONS: Sunitinib alone was not inferior to nephrectomy followed by sunitinib in patients with metastatic renal-cell carcinoma who were classified as having intermediaterisk or poor-risk disease. (Funded by Assistance Publique-Hôpitaux de Paris and others. [ABSTRACT FROM AUTHOR]

Abstract: Objective: The aim of the present study was to validate an experimental model of heterotopic renal allotransplantation. Such a model, more relevant to the human situation, has never been previously described. Materials and Methods: Pietrin pigs (40 to 50 kg) were used in the study. Through a midline incision, the left kidney was removed, washed, and preserved in a standard preservation solution (Celsior, Genzyme, France) for 20 hours at 4°C. Heterotopic autotransplantation was performed into the right iliac fossa onto the external iliac vessels with an end-to-side anastomosis and a nonstented uretero-ureteral anastomosis was performed. Results: Twenty-five renal allotransplantations were performed over a 5-month time period. Mean operating time progressively decreased and stabilized after 15 procedures (mean ± SD: 78.2 ± 19 minutes and 187.4 ± 18 minutes for left nephrectomy and transplantation, respectively) as morbidity decreased concomitantly. Suturing times for end-to-side anastomosis of the renal artery and vein onto the external iliac artery and vein were 21.9 ± 7 minutes and 34 ± 8 minutes (mean ± SD), respectively. Ten pigs died before the end of the experiment. ConcIusions: We have developed and validated the first nonrodent animal model of heterotopic renal autotransplantation relevant to the human anatomy and physiology. The procedure was easy to learn and safe. This model could be used to teach junior surgeons renal transplantation techniques and could also be used as a model to study ischemia-reperfusion injury in renal transplantation. [Copyright &y& Elsevier]

Summary Objective: To determine whether Belzer solution (Viaspan® , Bristol-Myers Squibb, Brussels, Belgium), which is more expensive than Eurocollins solution, was better at preventing delayed graft function (DGF) and whether it was cost-effective as it could potentially reduce post-transplantation complications. Method: The risk of occurrence of complications associated with the use of these two rinsing and preserving solutions was estimated from a survey of 106 patients undergoing renal transplantation between 1 January 1993 and 31 March 1998. Both efficacy and adverse outcomes were recorded along with the costs directly associated with the transplantation procedure in the hospital setting: hospitalization, rinsing and preserving solutions, medical and technical interventions and diagnostic tests. Results: For the 45 kidney grafts rinsed and preserved with Eurocollins (strategy S1: n 1 = 45) the cost/graft was estimated at 40 €. With Viaspan® (strategy S2: n 2 = 61) the corresponding cost/graft was 424 €. Logistic regression analysis showed that Viaspan® was better than Eurocollins solution (e β = 0·437; P = 0·05) in preventing DGF. Overall, S2 was less expensive than S1 , from the hospital's perspective. The mean difference per patient was 278 €, which amounts to a saving of 2% of the total cost per renal transplantation. For rinsing and preserving kidney grafts Belzer solution is therefore preferable to Eurocollins solution. [ABSTRACT FROM AUTHOR]

Abstract: Objective: Partial Nephrectomy (PN) in a solitary kidney is at risk of chronic kidney disease (CKD) stage V and/or haemodialysis (HD). Our objective was to determine predictive factors of CKD stage V in this population. Material & Methods: Data from 300 patients were retrospectively collected from 16 tertiary centres. Clinical and operative parameters, tumor characteristics and renal function before surgery were analyzed. Patients with and without CKD stage V (defined as MDRD<15ml/min) were compared using χ2 and Student-t tests for qualitative and quantitative variables, respectively. Predictive factors of CKD stage V were evaluated with a multivariable analysis using a Cox regression model. Results: Median age and BMI were 63 years old and 26kg/m², respectively. Most of the patients (65%) were male with an anatomic solitary kidney (88.3%). Median tumor size was 4cm and 98% were malignant tumors. Median operative time, blood loss and clamping time were 180min, 350ml and 20min respectively. Renal cooling was used in 19.3% and clamping of the pedicle was performed in 61.6%. Twenty five patients (8.5%) presented post operative CKD stage V at last follow-up and 18 underwent HD (6%) post-operatively because of acute renal insufficiency. There was no difference between CKD stage V and non CKD stage V patients concerning Charlson index, operative time (180min vs 179min, p = 0.39), blood loss (475ml vs 350ml, p = 0.51), use of renal cooling and type of clamping. Patients with CKD stage V were older (70 vs 63 years old, p = 0.005), had a lower baseline renal function (clearance MDRD 41 vs. 62ml/min, p<0.0001) and an increased tumor size (p = 0.02). Complications occurred in 91 patients (30%) with 16% of minor (Clavien 1–2) and 14% of major (Clavien > 2) complications, respectively. In multivariable analysis, baseline MDRD, BMI, and the occurrence of a minor complication were independent predictive factors of post operative CKD stage V. Conclusion: PN in a solitary kidney is at risk of post-operative CKD stage V and HD. Pre-operative altered renal function and post operative complications are the main predictive factors of permanent CKD stage V. [Copyright &y& Elsevier]