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Objective To report the results of the robot-assisted kidney transplantation (RAKT) experience performed in 10 European centres by members of the European Robotic Urology Section (ERUS)-RAKT group. Patients and Methods This is a multicentre prospective observational study of RAKT. Descriptive analysis of recipients and donor characteristics, surgical data, intraoperative outcomes, complications rate and functional results were collected and analysed. Results Between July 2015 and September 2019, 291 living-donor RAKTs were performed. Recipients were mostly male (189 [65%]), the mean Standard deviation (sd)age was 45.2 (13.35) years, the mean (sd)body mass index was 27.13 (19.28) kg/m(2), and RAKT was pre-emptive in 155 (53.8%) cases. Right and multiple arteries kidneys were used in 15.4%. The mean (sd)total surgical and re-warming time was 244 (70.5) min and 53.16 (15.27) min, respectively. In all, 17 patients presented with postoperative bleeding (5.7%). Five kidneys had delayed graft function; five (2%) were lost due to thrombosis and one due to acute rejection. Two patients had arterial stenosis, three had incisional hernias, six had ureteric stenosis, and nine had lymphoceles. Neither surgical nor re-warming times were correlated with postoperative serum creatinine levels (P > 0.05). Comparison of surgical data between the first 120 cases and the following 171 cases showed a significantly shorter total surgical time in the second group (265 vs 230 min,P = 0.005). Conclusions This is the largest European multicentre study of RAKT with good surgical and functional results competitive with open kidney transplant series, with a relatively short learning curve when performed in centres with a wide experience in open kidney transplantation and robotic surgery.

Background: Recently, robot-assisted kidney transplantation (RAKT) was recently introduced as renal replacement mini-invasive surgery. Objective: To report surgical technique, including tips and tricks, and the learning curve for RAKT. Design, setting, and participants: All consecutive RAKTs performed in the five highest-volume centers of the European Robotic Urological Society RAKT group were reviewed, and a step-by-step description of the technique was compiled. Surgical procedure: Surgeries were performed with Da Vinci Si/Xi. The patient was placed in the lithotomy position. The Trendelenburg position was set at 20-30 degrees and the robot was docked between the legs. Measurements: Shewhart control charts and cumulative summation (CUSUM) graphs and trifecta were generated to assess the learning curve according to rewarming time (RWT), intra/postoperative complications, and renal graft function (glomerular filtration rate) on days 7 and 30, and at 1 yr. Linear regressions were performed to compare the learning curves of each surgeon. Results and limitations: Arterial anastomosis time was below the alarm/alert line in 93.3%/ 88.9% of RAKTs, while venous anastomosis time was below the alarm/alert line in 88.9%/73.9%. The nonanastomotic RWT exceeded +3 standard deviation (SD) in 24.7% of procedures and +2SD in 37.1%. In only 46% cases, the RWT was below the alert line. The ureteroneocystostomy time was below +2SD and +3SD in 87.9% and 90.2% of cases, respectively. CUSUM showed that the learning curve for arterial anastomosis required up to 35 (mean = 16) cases. Complications and delayed graft function rates decreased significantly and reached a plateau after the first 20 cases. Trifecta was achieved in 75% (24/32) of the cases after the first 34 RAKTs in each center. Conclusions: A minimum of 35 cases are necessary to reach reproducibility in terms of RWT, complications, and functional results. Patient summary: Robot-assisted kidney transplantation requires a learning curve of 35 cases to achieve reproducibility in terms of timing, complications, and functional results. Synergy between the surgeon and the assistant is crucial to reduce rewarming time. High-grade complications and delayed graft function are rare after ten surgeries. Hands-on training and proctorship are highly recommended. (c) 2019 European Association of Urology. Published by Elsevier B.V. All rights reserved.

Fragestellung: Arbeiten zur prognostischen Qualität des UICC Tumor-Node-Metastasis Staging Systems (TNM) beim Nierenzellkarzinom (RCC) werden entscheidend vom klarzelligen Subtyp dominiert. Die wenigen Studien mit isolierter Analyse von Patienten mit papillärem RCC (papRCC) liefern widersprüchliche[zum vollständigen Text gelangen Sie über die oben angegebene URL], 42. Gemeinsame Tagung der Bayerischen Urologenvereinigung und der Österreichischen Gesellschaft für Urologie und Andrologie

Fragestellung: Das papilläre Nierenzellkarzinom (papRCC) ist mit ca. 10-15% der Fälle der zweithäufigste RCC-Subtyp. Obwohl Männer einer deutlich höhere Inzidenz für diesen Subtyp aufweisen, wurden bisher weder geschlechtsspezifische Unterschiede bezüglich klinischer[zum vollständigen Text gelangen Sie über die oben angegebene URL], 42. Gemeinsame Tagung der Bayerischen Urologenvereinigung und der Österreichischen Gesellschaft für Urologie und Andrologie

AIMS OF THE STUDY: To evaluate the outcome of kidney transplantation in children with low weight. METHODS: Retrospective review of the medical records of patients weighing 11 kg or less that received kidney transplantation between 2001 and 2013 were retrospectively reviewed. RESULTS: Fifty-nine kidney transplantations were performed in pediatric patients in our center, 12 of them were performed in patients weighing 11 kg or less (20%). The mean age of the recipient at the time of transplantation was 2 years (1-3.5); the mean weight was 9.4 ± 1.1 kg (8.3-11). The etiology of kidney failure was malformative in 42% of patients, inherited in 33%, glomerular in 8% and oiler etiologies in 17% of the patients. Two patients did not receive replacement therapy before transplantation (16.7%), nine received peritoneal dialysis (75%) and one of them hemodialysis (8.3%). Eleven of the grafts were from cadaveric donor (91.7%) and one of them from a living donor (8.3%). The mean donor age was 10 years (0.5-29). There was one case of acute graft thrombosis (8.3%) and one case of eventration requiring reoperation; there were no other major complications. Mean follow-up was 59 months (4-130). Overall survival (OS) was 100% at 1 year and 91.7% at 5 years. There was one death in a patient with mitochondrial disease with a functioning graft. Graft survival (GS) was 92% at 1 year and 75% at 5 years. CONCLUSION: Kidney transplantation is the treatment of choice for end-stage kidney failure in the young child. It provides good results in terms of patient and graft survival.

To evaluate the outcome of kidney transplantation in children with low weight.Retrospective review of the medical records of patients weighing 11 kg or less that received kidney transplantation between 2001 and 2013 were retrospectively reviewed.Fifty-nine kidney transplantations were performed in pediatric patients in our center, 12 of them were performed in patients weighing 11 kg or less (20%). The mean age of the recipient at the time of transplantation was 2 years (1-3.5); the mean weight was 9.4 ± 1.1 kg (8.3-11). The etiology of kidney failure was malformative in 42% of patients, inherited in 33%, glomerular in 8% and oiler etiologies in 17% of the patients. Two patients did not receive replacement therapy before transplantation (16.7%), nine received peritoneal dialysis (75%) and one of them hemodialysis (8.3%). Eleven of the grafts were from cadaveric donor (91.7%) and one of them from a living donor (8.3%). The mean donor age was 10 years (0.5-29). There was one case of acute graft thrombosis (8.3%) and one case of eventration requiring reoperation; there were no other major complications. Mean follow-up was 59 months (4-130). Overall survival (OS) was 100% at 1 year and 91.7% at 5 years. There was one death in a patient with mitochondrial disease with a functioning graft. Graft survival (GS) was 92% at 1 year and 75% at 5 years.Kidney transplantation is the treatment of choice for end-stage kidney failure in the young child. It provides good results in terms of patient and graft survival.

Qualitat de vida; Qüestionari; Insuficiència renal Calidad de vida; Cuestionario; Insuficiencia renal Quality of life; Questionnaire; Kidney Failure Background. Measures of fear of progression or recurrence of illnesses have been criticized for neglecting cross-cultural validity. Therefore, we assessed the psychometric properties of the Spanish version of the Fear of Kidney Failure Questionnaire (FKFQ), to determine whether postdonation fear of kidney failure (FKF) influenced the donors’ psychosocial status, and define variables that characterized donors with high FKFQ scores. Methods. We included 492 participants (211 donors) in a multicenter, 11-year, retrospective, cross-sectional study. Donors were classified with a Latent Class Analysis of the FKFQ-item scores and characterized with a multivariable logistic regression analysis. We calculated the risk ratio based on predicted marginal probabilities. Results. The Spanish version of the FKFQ showed acceptable psychometric properties. FKF was uncommon among donors, but we detected a small subgroup (n = 21, 9.9%) with high FKF (mean FKFQ score = 14.5, 3.1 SD). Compared with other donors, these donors reported higher anxiety and depression (38% and 29% of potential anxiety and depressive disorders), worse quality of life, and less satisfaction with the donation. Donors with high FKFQ scores were characterized by higher neuroticism combined with postdonation physical symptoms that interfered with daily activities. Conclusions. The FKFQ was cross-culturally valid, and thus, it may be used to assess the FKF in Spanish-speaking donors. New interventions that promote positive affectivity and evidence-based treatments for worry could be adapted for treating FKF.

Introduction: Sarcomatoid features (SF) correlate with worst survival outcomes in patients with primary metastatic renal cell carcinoma (mRCC). Some reports suggested a cut-off above 25% sarcomatoid features as a predictor of poorer outcome. We aimed to report survival outcomes on a large dataset of patients with SF treated with cytoreductive nephrectomy (CN). Materials and methods: A purpose built multi-institutional international database (REgistry of MetAstatic RCC- REMARCC project) was used for this retrospective analysis. Patients with diagnosis of mRCC treated with CN with or without metastasectomy were included. The cohort was stratified according to the presence of SF in the primary specimen. Kaplan Meier methods and Cox proportional Hazards Regression Analyses were used to estimate overall mortality rates. The reverse Kaplan Meier method was used to estimate the median (IQR) follow-up. Results: Overall 617 patients who underwent CN were included. Of all, 78 (12.6%) patients received synchronous/metachronous metastasectomy. A total of 118 (19.1%) patients had SF in the final specimen. The median involvement of the sarcomatoid component was 35.0% (IQR 10.0–72.5%). Patients with SF were more frequently classified as poor prognosis according to Heng’s criteria (44.9 vs. 33.3%, p = 0.022). Moreover, patients with sarcomatoid features harbored more frequently locally advanced disease [pT3-4 stage tumors (88.1 vs. 73.7%, p = 0.003) and pN1 tumors (28.8 vs. 18.22%, p = 0.025)]. The median follow-up was 55.1 (IQR 25.9–120.6) months. Overall, 395 (64.0%) deaths were recorded in the whole cohort. The median overall survival was shorter for patients with SF (13.1 vs. 27.9 months, p < 0.001). However, neither patients with a SF >35% nor those with a SF >50% showed higher overall mortality rates than those with 50% in the specimen was not predictive of higher mortality rates within patients with SF. These results suggest that all patients with a SF on primary tumor should be carefully followed independently of percentage of sarcomatoid dedifferentiation.

Introduction & Objectives: As treatment paradigms for management of metastatic renal cell carcinoma (mRCC) have shifted, the role of surgical metastasectomy in management of mRCC has been in similar flux. We examined impact on survival of surgical metastatectomy stratified in the setting of different mRCC risk groups. Materials & Methods: Multicenter retrospective analysis of patients from the REMARCC (REgistry of MetAstatic RCC) database. The cohort was subdivided utilizing Motzer RCC criteria (low, intermediate, and high risk), and impact of metastasectomy was analyzed via multivariable analysis (MVA) and Kaplan Meier analysis within each Motzer subgroup (KMA). Primary outcome was overall survival (OS) and secondary outcome was cancer specific mortality (CSM). Results: 431 patients (59 low risk, 274 intermediate risk, 98 high risk) with median follow-up of 19.2 months were analyzed. Metastasectomy was performed in 22 (37%), 66 (24%), and 32 (16%) of low, intermediate and high risk groups (p=0.012). Risk groups differed significantly with respect to ECOG performance status (p

Aim of the study: Recent evidence outlined that not all patients with mRCC might benefit from CN. However, there is lack of data on perioperative morbidity after this procedure. We aimed to investigate the impact of surgical approach on perioperative outcomes and surgical complications relying on a multicenter international registry. Materials and methods: Clinical data of 681 patients with mRCC undergoing CN at 11 centers included in the REgistry of MetAstatic RCC (REMARCC) from January 2014 to December 2017 were retrospectively collected. Patients with complete data on demographics and comorbidity profiles were included in final analysis. Study endpoints were: a) postoperative complications, assessed and graded using the modified Clavien-Dindo scale, and b) 30th day readmission rate. Results: Overall, 369 (54.2%) patients (247 open CN [OCN] and 122 minimally-invasive CN [MICN]) were considered. Patients treated with OCN had a significantly higher cT stage (p = 0.01), tumor size (p < 0.0001) and cN stage (p = 0.04). Conversely, there was no difference in terms of gender, age, Charlson comorbidity index, body mass index, site of metastasic lesions and baseline hemoglobin level, LDH level, glomerular filtration rate and calcemia. Lymph node dissection (LND) rate and renal vein/vena cava thrombectomy were significantly higher in the OCN compared to the MICN (p < 0.0001 and p = 0.001, respectively). Median estimated blood loss was significantly lower in the MICN compared to the OCN group (100 vs 450 cc, p < 0.0001). The rate of removal of adjacent organs beyond the tumorbearing kidney was not significantly different among the two groups. Patients with MICN compared to OCN had a significantly lower intraoperative (10% vs 22.6%, p = 0.004), overall postoperative (18% vs 38.6%, p < 0.0001) and major postoperative (2.5 vs 8.2%, p = 0.03) complications and lower median length of stay (5 vs 8 days, p < 0.0001). Perioperative mortality was reported in 3 patients in the OCN group. Readmission rate was 7.1% in both groups. Discussion: MICN was feasible and achieved acceptable perioperative morbidity in selected patients with mRCC. The main study limitation is the retrospective design with risk of selection and attrition bias.