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Purpose: To assess epidemiologic characteristics, clinical and pathologic patterns of presentation, and treatment strategies in a contemporary population with renal masses (RMs). Methods: The Clinical Research Office of the Endourological Society collected prospective epidemiologic, clinical, and pathologic data on consecutive patients with RMs who were treated during a 1-year period in 98 centers worldwide. Preoperative assessment and treatment were performed according to local clinical practice guidelines. Results: From January 2010 to February 2012, 4288 patients (4355 cases, 4815 tumors) were treated for a RM. The mean age of the cohort was 61.5 years, and the ratio male:female 1.8:1. Caucasians represented 75% of the population, and the median body mass index was 27. The cohort exhibited a high rate of comorbidity (65.6%), including a 48.5% rate of hypertension; one-third of patients had a combination of two or more comorbidities. One-third of patients (36%) had risk factors for renal-cell carcinoma (RCC), of which smoking and obesity were the most common. Diagnosis was incidental in 67% of cases, and 22.2% of cases had chronic kidney disease stage ≥III at presentation. Median radiologic size was 44 mm (range 2-300 mm) and 68% were cT1. Radical nephrectomy and nephron-sparing surgery (NSS) including ablation were performed in 52% and 46% of cases, respectively, while 3.6% of cases were actively surveyed. Median pathologic size was 43 mm (range 2-300 mm) and 63% of the RCCs were pT1. Conclusions: Current patterns of presentation of RMs are consistent with the decreasing trends in age and clinical or pathologic size and increasing incidental diagnosis. Patients exhibit a considerable basal comorbidity and presence of risk factors for RCC. Half of the cases are treated by a nephron-sparing modality with an increase in the penetration of NSS techniques in the contemporary urologic practice. [ABSTRACT FROM AUTHOR]

Background and Purpose: The vast increase in recent publications on renal mass biopsy (RMB) suggests an increased interest in the subject. The objective of the survey was to assess the use of RMB in current urologic practice, including related factors such as indications and patterns in practice. Methods: The link to a web-based questionnaire () was sent to all registered e-mail addresses (1854) of members of the Endourological Society in December 2010. The questionnaire contained six epidemiologic questions, 10 regarding patterns of practice, one regarding the influence of the literature, and one on future techniques. Chi-square test (for trends) was used to assess statistical significant differences among categorical answers. Results: In total, 190 responders completed the survey of whom 73% indicated performing RMB 'never' or 'rarely' compared with 9% performing RMB in 25% to 100% of cases. Thirteen percent of responders reported never to take a RMB. Of the latter, significantly fewer practice in university hospitals (6% vs 20%-30%, P=0.003). Main indications to perform RMB are still tumors in solitary/transplant kidneys and in metastatic disease. Lack of influence on clinical management and risk of false negatives were the main reasons not to perform biopsies. Sixty-one percent prefer histological biopsies compared with 8% who prefer cytological aspiration; 31% indicated that they combine both techniques. Other tissue differentiation techniques (Optical Coherence Tomography, Raman-spectroscopy) are unknown to 65% of urologists. Conclusion: RMB is not yet applied widely in urologic practice, with academic urologists performing RMB less infrequently. Core biopsies are still preferred, although combined with cytologic punctures by a considerable number of responders. [ABSTRACT FROM AUTHOR]

Objective: To determine if the application of using standard tools on tumor complexity and comorbidity indexes may replace the traditional choice of nephron-sparing procedure (NSP) based on clinical maximal tumor diameter (cMTD), age, and comorbidity. Patients and Methods: Anatomic complexity scores (PADUA and RENAL) and Charlson comorbidity index (CCI) and CCI age-adjusted (CACI) were applied to 261 cases of either nephron-sparing surgery (NSS) or cryoablation (CA). Patient- and tumor-related preoperative variables, PADUA, RENAL, CCI, and CACI, were evaluated for their association and as treatment predictors in uni- and multivariate regression analysis. Discriminative ability of each of the models generated was compared for their receiver operating curve area under the curve (AUC). Survival analysis was performed using log rank tests. Results: In total, 124 cases underwent partial nephrectomy and 137 cases CA. cMTD, RENAL, PADUA, age, and CACI were independently associated with the choice of NSS. Five models integrating a combination of age, cMTD, CACI, PADUA, and RENAL (scores and complexity groups) showed an AUC >0.72 to predict the odds of receiving NSS. The discriminative ability of these five models was not statistically significantly different. Conclusions: cMTD, RENAL, PADUA, age, and CACI are preoperative variables independently associated with the choice of NSP. Models incorporating tools on tumor anatomic complexity and CACI may replace the decision-making in the type of NSP based on cMTD and age. The use of these models can be of value for future standardization and comparison. [ABSTRACT FROM AUTHOR]

Purpose: To assess the use of prognostic factors and models in renal-cell carcinoma (RCC) and to gain insight in the motivations precluding prognosis estimation and the use of prognosticators. Materials and Methods: A questionnaire was sent to 110 urologists involved in the Clinical Research Office of the Endourological Society (CROES) Global Renal Mass Study. Frequencies were gathered using descriptive statistics. Results: The majority of the 86 responders worked in a university hospital in Europe. Most of the urologists (97.7%) used the tumor-node-metastasis (TNM) classification, and 44% performed prognosis estimations in all patients. The main reason not to estimate prognosis was lack of accuracy (20.9%) and of additional benefit (11.6%). In addition, clinical, laboratory, or pathologic factors were used by 89.5% of the urologists and biomarkers by 16.3%. Preoperative models were used by 20.9%, postoperative models by 38.4%, and metastatic models by 38.4%. The Raj and Motzer models were the most used in preoperative and metastatic settings, while no predominance among the different postoperative models was seen. The most important reasons to skip the use of models were 'lack of additional value' and 'lack of familiarity' reported by 30.2% and 27.9% of the responders, respectively. Conclusions: The TNM is the mainstay for assessing prognosis in RCC. Our data indicate that penetration of prognostic systems is, at most, moderate, suggesting limited use outside original developmental settings. On the contrary, clinical, laboratory, and pathologic factors are used by almost all urologists for prognosis estimations. The most important reason not to use models is the lack of additional value. [ABSTRACT FROM AUTHOR]

Purpose: Stringent radiological follow-up is essential after renal tumor ablation. Drawbacks of postablation follow-up by contrast-enhanced computed tomography (CECT) are the associated ionizing radiation and nephrotoxic contrast agent. Contrast-enhanced ultrasound (CEUS) has shown potential to demonstrate microvasculature without using either ionizing radiation or toxic contrast agent. We assessed the concordance of enhancement patterns of CEUS and CECT/MRI in cryolesion assessment after laparoscopic renal cryoablation (LCA). Methods: From 01/2006 to 01/2009, a CEUS was performed before and after LCA (3 and 12 months) in addition to regular CECT/MRI. Using an enhancement score (0=no enhancement, 1=rim enhancement, 2=diffuse enhancement, 3=localized enhancement, 4=no enhancement defect), the cryolesion was assessed by both modalities, and concordance of enhancement score was assessed. Results: In total, 45 tumors were included (29 biopsy proven renal cell carcinoma (RCC), mean size 2.66 cm). One cryoablation failed, resulting in a nonenhancing cryolesion apart from the persisting renal tumor. There were no postablation recurrences during the study period. Pre-LCA: Both modalities were available in 26 cases. In 20 out of 26, there was concordance of enhancement score (77%, all cases score 3 or 4). Three months: Both modalities were available in 32 cases. Enhancement score corresponded in 23 out of 32 cases (72%). Seven cases showed enhancement on CECT/MRI ('1' in six cases, '4' in one case) with enhancement score '0'on CEUS. Two cases showed enhancement on CEUS without enhancement on CECT/MRI (specificity 92%, negative predictive value [NPV] 77%). Except one case, all enhancement resolved on subsequent imaging. Twelve months: Both modalities were available in 21 tumors. Enhancement score corresponded in 19 out of 21 cases (91%). Two cases showed enhancement on CEUS without enhancement on CECT/MRI (specificity 90%, NPV 100%). Conclusion: This pilot study shows that CEUS is a safe imaging technique with high concordance of enhancement score between CEUS and CECT/MRI. While cross-sectional imaging seems sensible to demonstrate successful ablation at first follow-up, CEUS might be used to diminish the burden of contrast-enhanced cross-sectional imaging in the long-term follow-up. [ABSTRACT FROM AUTHOR]

Purpose: To define in which patients who present with microscopic or macroscopic hematuria CT urography (CTU) is indicated as an imaging mode for the upper urinary tract (UUT). Patients and Methods: We conducted a prospective study on consecutive patients who attended a modern protocol-driven hematuria clinic from January 2006 to February 2010. Standard tests (history taking, physical examination, urinalysis via dipstick method, ultrasonography of kidneys and bladder performed by urologists, cystoscopy, and cytology) were directed to all patients, whereas the mode of additional UUT imaging (ultrasonography by a radiologist or four-phase CTU/magnetic resonance (MR) urography (MRU) when CTU was contraindicated) was selected according to a risk factor-based management algorithm. The added value of cross-sectional urography (CTU/MRU) supplementary to ultrasonography (by urologists) to detect renal masses, UUT tumors, and stones was assessed. Univariate and multivariate analysis on predictive factors for cross-sectional urography result were performed. Results: From the total of 841 patients, lesions that might account for hematuria could not be identified in 462 (54.9%), whereas in 250 (29.7%) and 124 (14.7%) patients, hematuria was from benign and malignant disease, respectively. Cross-sectional urography revealed relevant UUT lesions in 73 of 525 (13.9%) patients. Only result of ultrasonography (odds ratio [OR] 7.7, 95% confidence interval [CI] 4.0-14.9), P<0.001) and type of hematuria (OR 2.6, 95% CI 1.3-5.1, P=0.01) were significant predictors for cross-sectional urography result. In 44 of 456 (9.6%) patients with no abnormalities on ultrasonography, CTU/MRU revealed that these were false negatives, with most lesions missed being stones. In 253 of 309 (81.9%) patients with macroscopic hematuria, no lesions were detected in the UUT on CTU/MRU, in contrast to 199 of 216 patients (92.1%) with microscopic hematuria. Conclusion: For patients who present with microscopic hematuria, ultrasonography is sufficient to exclude significant UUT disease. For patients with macroscopic hematuria, the likelihood of finding UUT disease is higher, and a CTU as a first-line test seems justified. [ABSTRACT FROM AUTHOR]