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INTRODUCTION AND OBJECTIVES: Partial nephrectomy (PN) is offered to patients with small renal masses to preserve renal function and does not compromise cancer specific outcomes. Hypertension (HTN) and diabetes (DM) are the leading medical causes of chronic kidney disease (CKD) and many patients undergoing PN have these conditions. The present study therefore sought to assess the influence of DM or HTN on renal function outcomes following robotassisted PN (RPN). METHODS: Using an IRB approved multi-institution kidney cancer database, subjects who underwent RPN for a clinical stage T1 renal mass with normal baseline kidney function (estimated glomerular filtration rate [eGFR] >60 mL/min/1.73m) and follow-up of > 2 weeks were included in the analysis. Patients were categorized based on the presence of either HTN or DM (Group 1) or neither (Group 2). Postoperative eGFR was categorized into 3-month intervals with maximum follow-up limited to 18 months. Renal function outcomes were compared using a mixed effects ANOVA model adjusting for age, body mass index (BMI) and RENAL nephrometry score. A Wilcoxon rank sum test was used to compare distribution of continuous variables and Chi-square test to compare the CKD upstaging between groups. RESULTS: We identified 324 patients with a baseline eGFR>60 mL/min/1.73m (198 with either DM or HTN, 126 with neither). There was no difference in baseline eGFR and median follow up between groups. Following RPN, there was no difference in eGFR, CKD upstaging or renal function recovery over time (figure 1). The rate of progression to CKD stage 3 did not differ between groups 1 and 2 (19% vs. 18%, p1⁄40.84). In a similar analysis of 159 patients with an eGFR >90 mL/min/ 1.73m (92 with either DM or HTN, 67 with neither) no difference in baseline eGFR, length of follow up, eGFR following RPN, CKD upstaging or renal function recovery was found (figure 1). The rate of progression to CKD stage 2 or higher did not differ between groups (48% vs. 55%, p1⁄40.34). CONCLUSIONS: In patients with a normal baseline renal function (eGFR > 60 mL/min/1.73m), the presence of DM or HTN are not independent predictors of worse renal function outcomes following RPN.

We describe the pathophysiology, differential diagnosis and urodynamic findings in patients with a large capacity bladder.This was a retrospective, observational study of 100 consecutive patients with voiding dysfunction and a cystometric bladder capacity of greater than 700 ml. Clinical data, cystometric bladder capacity and other urodynamic findings were evaluated. Bladder outlet obstruction and impaired detrusor contractility were defined by the Schaefer nomogram in men and the Blaivas-Groutz nomogram in women.A total of 56 men and 44 women 36 to 97 years old (median age 75, mean 71.2) with a bladder capacity of 700 to 5,013 ml (median 931, mean 1,091) were studied. The primary pathophysiological diagnoses were bladder outlet obstruction in 48% of cases, impaired detrusor contractility in 11%, absent detrusor contractility in 24% and normal detrusor pressure/uroflow study in 17%. Bladder outlet obstruction was attributable to anatomical obstruction in 34% of patients, acquired voiding dysfunction in 11% and detrusor-external sphincter dyssynergia in 3%. In patients with detrusor contractions the initial contraction occurred at a median of 1,000 ml (mean 1,154, range 86 to 5,000). Associated diagnoses in men included benign prostatic enlargement in 52% and neurological disease in 14%, and in women they were pelvic organ prolapse in 27%, stress incontinence in 18% and neurological disorders in 9%.The etiology of large capacity bladder is multifactorial and often a potentially remediable underlying condition exists. A large capacity bladder may be accompanied by bladder outlet obstruction, impaired or absent detrusor contractions, or normal detrusor pressure/uroflow studies. When detrusor contractions are present, they usually occur only at large bladder volumes. Therefore, it is important during cystometry to fill the bladder until capacity is achieved.

INTRODUCTION AND OBJECTIVES: Ureteral colic due to an obstructing stone is a common presentation to the emergency department. We sought to evaluate how often serum and urine studies were unremarkable in patienst with this presentation. METHODS: Two hundred thirty-two consecutive patients evaluated in an urban tertiary care emergency department and who were diagnosed with an obstructing ureteral stone on computerized tomography (CT) were evaluated. Inclusion criteria were as follows: ureteral stone diagnosed on CT, urine dipstick and serum WBC checked. Studies were considered “normal” if urine dipstick showed 0 RBC, 0 WBC, and was nitrite negative AND if serum WBC was < 12.0. RESULTS: Mean patient age was 46.9 years (SD 15.4), gender prevalence was 35.8% female:64.2% male, mean axial stone diameter was 4.0 mm (SD 2.0), and mean serum WBC was 10.1 (SD 3.7). Stone position was proximal ureter e 24.6%, distal ureter e 27.1%, and ureterovesical junction e 48.3%. Completely normal urine dipstick and serum WBC was seen in 47 patients (20.2%), whereas 185 patients (79.7%) demonstrated at least a single abnormality of urine dipstick or WBC. On mulvariate logistic regression, neither age, gender, stone location, or stone size were significant predictors of the presence or absence of laboratory abnormalities. CONCLUSIONS: Up to 20% of patients presenting with ureteral colic and ureteral stones will not demonstrate abnormalities of urine dipstick or serum WBC. These data may be helpful in selecting which patients may benefit from additional imaging or workup in cases when the diagnosis is not obvious.