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Objectives: To study the effect of central tumor location on the glomerular filtration rate (GFR) after partial nephrectomy for renal cortical tumor. Methods: We reviewed our institutional database to identify patients who had undergone partial nephrectomy from January 1995 to July 2005. Central tumors were defined as those encroaching on the collecting system or renal sinus or that did not distort the renal contour; all others were categorized as peripheral on preoperative abdominal imaging. We calculated the GFR preoperatively, during the hospital stay, and at 1 and 12 months after surgery. Linear regression models were fit to determine the association of tumor location with the changes in GFR at each period, after controlling for age, sex, operative and ischemic times, comorbidities, and blood loss. Results: A total of 248 central and 333 peripheral tumors were available for analysis. Patients with central tumors were younger than those with peripheral tumors (62 versus 59 years, P = 0.014) and experienced longer intraoperative renal ischemia times (40 versus 29 minutes, P <0.001) and longer operations (195 versus 179 minutes, P = 0.004). On multivariate analysis, tumor location was not significantly associated with the change in GFR at any of the intervals, after adjusting for the covariates. Conclusions: The results of our study have indicated that tumor location does not appear to affect long-term renal function. Thus, partial nephrectomy should not be withheld from this subset of patients. [Copyright &y& Elsevier]

Objective: To assess the urologist's impact on prostate needle core biopsy variables including number of containers submitted, total core length, longest core length, and individual core length threshold values, and to elucidate the relationship between these variables and cancer detection rate within a recent cohort.Methods: A retrospective search was performed to identify patients who had an extended transrectal ultrasound-guided prostate needle core biopsy between 2008 and 2013.Results: One thousand one prostate biopsies were analyzed. Total core length (mean 13.2-22.9 cm, P < .001) significantly varied by submitting urologist but did not impact cancer detection rate per case. Increased core length per container impacted the cancer detection per container (P < .001). The number of cores that met threshold values of 0.5, 1.0, and 1.5 cm as well as longest individual core length (mean 1.7-2.2 cm) significantly varied between urologist (P < .001), although there was no association between these variables and cancer detection. Container number differed significantly between urologists (P < .001) but did not correlate with cancer detection. For the single urologist with a change in his submission protocol during the study period, a nonsignificant change in cancer detection was noted when comparing 12-14 containers vs 6-9 containers.Conclusion: Submitting urologist significantly impacts prostate biopsy metrics. An increased amount of tissue per container was associated with higher rates of cancer per container. A nonsignificant change in cancer detection rate was observed when container number was reduced from 12-14 to 6-9. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the viability of glomeruli in the peritumor parenchyma of partial nephrectomy specimens removed for renal cell carcinoma (RCC) and relate it to kidney function, to better understand the contribution of peritumor parenchyma to renal function.Materials and Methods: A retrospective analysis of 53 partial nephrectomies containing RCC was performed. Glomeruli within 0.25-cm increments from the tumor were quantified and histologically assessed for viability. Tumor size, minimum and maximum margin size, and pre- and postoperative estimated glomerular filtration rate (eGFR) were obtained.Results: Glomerular viability positively correlated with distance from tumor with mean viable glomeruli in successive 0.25-cm increments of 0-0.25 cm, 58%; 0.25-0.5 cm, 80%; 0.5-0.75 cm, 90%; and 0.75-1.0 cm, 92%. Glomerular viability near the tumor did not correlate with preoperative eGFR, whereas decreased viability further from the tumor did correlate with worse preoperative eGFR. Tumor size showed a nonstatistically significant positive trend with minimum (median 0.15 cm) and maximum margin (median 0.7 cm) sizes. Percent change of glomerular filtration rate did not correlate with margin size (P = .190).Conclusion: Renal parenchyma immediately adjacent to RCC contains fewer viable glomeruli compared with the parenchyma further from the tumor. Based on this information, attempts to preserve all non-neoplastic renal parenchyma via a surgical margin approaching zero may not necessarily result in clinically relevant differences in the amount of viable glomeruli remaining or the renal function preserved. [ABSTRACT FROM AUTHOR]

Abstract: Objectives: To report the technique and early outcomes of nerve-sparing laparoscopic radical cystectomy with continent orthotopic ileal neobladder in selected male and female patients with bladder cancer. Methods: Since 2000, 52 patients have undergone laparoscopic radical cystectomy at our institution, with nerve-sparing laparoscopic radical cystectomy performed in 5 patients. In the nerve-sparing technique, transection of the lateral vascular pedicle and the posterior dissection proceeds closer to the bladder, at some distance from the rectum. Hem-o-lock clips were used for hemostasis, avoiding the need for any energy source near the neurovascular bundle (NVB). In the male, the identification and complete release of the NVB before division of the urethra minimizes damage to the NVB along the prostatic apex. In the female, preservation of the uterus, fallopian tubes, ovaries, and vagina, maintenance of the endopelvic fascia, and minimal mobilization distal to the urethra facilitates nerve sparing. Results: The median operative time was 10 hours, blood loss was 400 mL, and the length of stay was 5 days. No patient required blood transfusion, and one had a postoperative complication. All patients were free of recurrence at a median follow-up of 30 months. At 12 months, nocturnal and daytime continence was preserved in 100% and 75% of patients, respectively. Sexual function was preserved in the female patient and 2 of the 4 male patients. Conclusions: With careful attention to the anatomic location of the NVBs and a precise operative technique, nerve-sparing laparoscopic radical cystectomy can be performed in appropriately selected male and female patients with organ-confined bladder cancer. [Copyright &y& Elsevier]