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Introduction: The litigious environment encompassing the medical-legal domain is an increasing concern for surgical fields, with urology being no exception. The objective of our study was to systematically review, evaluate, and summarize the factors associated with oncologic nephrectomy litigation to determine possible factors contributing to verdicts or settlements. Materials and Methods: Publicly available verdict reports were retrieved using the Westlaw ® legal database (Reuters). Cases were identified using the search term "nephrectomy" with dates ranging from January 1, 1990 to July 1, 2019. Each case was evaluated by two independent reviewers for defendant specialty, alleged breach in treatment, resulting complications, verdict outcomes, and indemnity payment. Complications were determined to be preoperative, perioperative, and postoperative. Data were analyzed using SPSS software to produce the descriptive statistics. Results: After accounting for duplicates and irrelevant cases, a total of 103 cases were analyzed with more than three-fourths being radical nephrectomies (78%). The most common claim was preoperative negligence (48%); however, negligence in perioperative care received the highest average monetary payment of $5,493,151. Forty-one percent of cases were perioperative with the majority being attributed to vascular injury (46%). The type of perioperative negligence claims and its average payment were found to be statistically significant ( p  = 0.042). Overall, 57% of cases denied the plaintiff's claims, whereas 28% were awarded. Conclusions: Our data show that although the highest number of cases were caused by preoperative negligence, perioperative negligence accounts for the highest settlement awards. This review provides insights into stages of management in the surgical management of renal cell cancer patients that may be subject to litigation.

Background and Purpose: Renal fossa recurrence of renal-cell carcinoma (RCC) after radical nephrectomy historically necessitates open surgical resection. Cryoablation provides a minimally invasive alternative to open resection for local recurrence. We describe our experience with percutaneous cryoablation in three patients who were experiencing fossa recurrence., Patients and Methods: We retrospectively reviewed medical records of three patients with renal fossa recurrence of RCC who were treated with percutaneous cryoablation., Results: Percutaneous cryoablation was well tolerated; no complications were noted, and patients were discharged within 23 hours. One patient needed an additional cryoablation procedure, and one patient underwent subsequent open extirpation. Metastatic disease developed in one patient, while the other two patients remain negative for disease by axial imaging and percutaneous biopsy. All patients are alive at 43 months (range 22-54 months)., Conclusions: Percutaneous cryoablation, a minimally invasive intervention, has low morbidity and may be offered as an alternative to extirpation, although long-term oncologic data are lacking.

Background and Purpose: Laparoscopic renal cryoablation is an emerging minimally invasive management option for T(1) renal lesions. In an analysis of patients treated with laparoscopic cryoablation for renal lesions, our objective was to compare the treatment outcomes in patients with exophytic/partially exophytic and endophytic (peripheral but completely intrarenal) lesions., Patients and Methods: We retrospectively reviewed medical records of 32 consecutive patients with anterior renal lesions who were treated with laparoscopic renal cryoablation between 2003 and 2005. Biopsy samples were obtained from the majority of lesions intraoperatively. The lesions were managed with 17 gauge needles and two freeze/thaw cycles. Follow-up was performed with CT scans at 3, 6, and 12 months, and then yearly. Treatment failures were defined as continued enhancement on CT or growth of the lesion. Statistical analysis was performed using t-test, correlative, and multiple regression analysis., Results: A total of 35 lesions in 32 patients were identified. Median lesion size was 1.9 cm. Median age was 67 years, with most patients having significant comorbidities. The median preoperative and postoperative creatinine level was 1.3 and 1.5 mg/dL (P = 0.38). Of the biopsy samples from 27 of 35 lesions, 18 showed renal cell carcinoma, 5 were found to be benign, and findings from 4 were inconclusive. Three lesions were completely endophytic. The median follow-up was 18 months, with treatment failures noted in 2 of 35 lesions (6%), both of which were endophytic (P < 0.0001). Multivariate analysis revealed that only the endophytic status of a lesion was a predictor of failure (P < 0.05). These were lesions that relied entirely on intraoperative ultrasonography for targeting, which suggests that failure was a technical error., Conclusions: Experience with renal cryoablation is still evolving. Our series further defines the role of laparoscopic renal cryoablation and its limitations in managing peripheral endophytic tumors. Completely endophytic lesions have a significantly higher risk of treatment failure. Reliance solely on intraoperative ultrasonography with no visual cues is a risk factor for treatment failure.