Search

Background: The oncologic safety of blunt tumor enucleation (TE) of renal cell carcinoma (RCC) depends on the presence of a continuous pseudocapsule (PS) around the tumor and on the possibility of obtaining negative surgical margins (SMs). Objective: To investigate the PS and SMs after TE to define the real need to take a rim of healthy parenchyma around the tumor to avoid the risk of positive SMs. The risk of PS invasion related to other clinical and pathologic variables was also evaluated. Design, setting, and participants: Between September 2006 and December 2007, data were gathered prospectively from 187 consecutive patients who had kidney surgery. Overall, 90 consecutive patients who had TE for RCC were eligible for the study. All specimens were evaluated using an image analyzer by a dedicated uropathologist. Intervention: TE was done by blunt dissection using the natural cleavage plane between the tumor and the normal parenchyma. Measurements: PS,SM, and routinely availableclinical andpathologic variableswere recorded.

Objectives To evaluate the safety and efficacy of simple enucleation as a conservative treatment for pT1a RCC, and to report on the incidence of major complications, local recurrence, and progression-free and disease-specific survival rates. Methods We retrospectively reviewed the data of 232 patients who had nephron-sparing surgery (NSS) by simple enucleation between 1986 and 2004 for sporadic, unilateral, pathologically confirmed pT1a RCC. The patients' status was evaluated last in September 2005. The mean (median, range) follow-up was 76 (61, 12–225) months. Results The mean (SD, median, range) tumor greatest dimension was 2.8 (0.78, 2.85, 0.6–4) cm. The histopathologic review according to the International Union Against Cancer and American Joint Commission for Cancer (1997) classification revealed 198 clear cell (85.3%), 18 papillary (7.8%), 15 chromophobe (6.5%) and one (0.4%) collecting duct RCCs. There were no major complications, such as prolonged acute tubular necrosis/chronic renal insufficiency and bleeding requiring open reoperation. One patient developed postoperative late retroperitoneal fluid collection consistent with urinoma, which required aspiration, drainage position and JJ stenting for 3 weeks. The 5- and 10-year cancer-specific survival were 96.7% and 94.7%, respectively. The 5- and 10-year progression-free survival were 96% and 94%, respectively. Overall, 13 (6.4%) patients had disease progression, three of whom had local recurrences alone (1.5%) elsewhere in the kidney; none had local recurrence at the level of the enucleation bed. Conclusions Simple tumor enucleation is a safe and acceptable nephron-sparing treatment that provides excellent long-term local control and cancer-specific survival rates.

To present the oncological outcome of the antegrade radical prostatectomy in the whole series of consecutive patients treated over an 18-yr period, and to report the functional results and complications of the last 488 patients.We reviewed the clinicopathological data of 845 patients treated between 1988 and 2005. Complete data on continence, potency, and complication were available on the last 488 patients treated between 2000 and 2005.Positive surgical margins were detected in 12.8% of patients. The mean follow-up was 49 mo. The 8-yr biochemical recurrence-free survival rates were 84.1% for pT2, 69.9% for pT3a, and 37.3% for pT3b disease (p0.0001). The multivariate analysis showed stage, PSA, and Gleason score as significant independent predictors of biochemical recurrence-free survival. After 12 mo, 94.1% of patients were continent, and 69.6% of patients who had bilateral nerve-sparing prostatectomy were potent. Mean estimated blood loss was 223 cc; overall incidence of complication was lower than 15%.Antegrade radical prostatectomy provides a low incidence of positive margins and an optimal cancer control. This technique can provide a low incidence of complications, reduced blood loss, and optimal functional results in terms of recovery of continence owing to a complete definition of the anatomical boundaries of the apex. Moreover, it can provide a less challenging nerve-sparing procedure with similar results to those reported by the retrograde approach.

A 10-cm-long refluxing ureteric stump following nephrectomy in a woman with a neurogenic bladder was successfully treated endoscopically. The procedure consisted of endoluminal occlusion with a fibrin adhesive complex followed by meatal sealing by a submucosal injection of polytetrafluoroethylene paste.

A boy presenting with a small bladder and refluxing blind-ending ureteral stumps following multiple attempts at ureteral reimplantation and supravesical diversion with a high left-to-right transureteroureterostomy and right cutaneous ureterostomy underwent successful undiversion. Surgery consisted of bilateral ureterectomy and ileocecocystoplasty, with intussusception of the ileocecal valve and anastomosis of the ileal tail to the right renal pelvis.