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Multifocal renal cell carcinoma (RCC) has been reported in up to 25% of all radical nephrectomy specimens. Modern imaging tends to underestimate the rate of multifocality. Recognition of multifocality before treatment may guide physicians and patients to the type of intervention and tailor long-term follow-up.Our aim was to develop and assess preoperative nomograms to predict occult multifocal RCC.We evaluated 560 consecutive patients undergoing radical nephrectomy for clinically localized suspected sporadic RCC between 2000 and 2008 in a tertiary center. Clinically manifest multifocal lesions were excluded. Logistic regression models were used to assess the potential risk factors of occult multifocality with and without pathologic variables that may be available with preoperative biopsy. Nomograms were developed and assessed for diagnostic properties.All patients underwent radical nephrectomy.Assessments of risk factors for occult multifocal RCC were obtained using regression models and nomograms.The incidence of occult multifocality was 7.9%. Significantly associated predictors of multifocality were male gender, family history of malignancy other than RCC, radiographic size of the lesion, histologic subtype other than clear cell, and Fuhrman grade IV. The two designed nomograms had 0.75 and 0.82 concordance indices, respectively.Our data suggest that occult multifocal RCC is more frequently associated with small (2-4 cm) renal lesions. Male gender, family history of kidney cancer, histologic subtype, and grade are strongly associated with an increased risk of occult multifocal RCC. The developed nomograms had good predictive accuracy that was enhanced when combined with pathologic variables.

Study Type--Therapy (case series) Level of Evidence 4. What's known on the subject? and What does the study add? The role of the vacuum erection device (VED) has increased with its use in combined therapy with a phosphodiesterase type 5 inhibitor (PDE5i) for penile rehabilitation after radical prostatectomy (RP) and radiotherapy. The advantages of the VED are non-invasive, cost-effective, and a possibility of preventing shrinkage of penis length. Albeit current widespread use of penile rehabilitation programmes for post-RP erectile dysfunction, independent predictors for the rehabilitation participants, as well as for its treatment success have not been fully investigated. In the present study, we have added several new predictors for rehabilitation participation, e.g. African-Americans and higher preoperative sexual function. Conversely, higher preoperative PSA concentrations and the presence of positive surgical margins were predictors for avoidance of rehabilitation. Notably, there was a primary surgeon difference, which had a trend for predicting outcome of the rehabilitation among the participants, implying their surgical technique and follow-up might influence success of the rehabilitation.• To investigate baseline demographic and clinicopathological characteristics of men who participate in our penile rehabilitation programme after radical prostatectomy (RP). • To determine predictors for participation in rehabilitation, as well as successful rehabilitation outcome using multivariable logistic regression analyses.• We analysed data on 2345 consecutive patients who underwent RP between 2001 and 2009 in our institution. • The decision to participate in penile rehabilitation using phosphodiesterase type 5 inhibitor (PDE5i) with a vacuum erection device (VED) was based on the patient's choice after post-RP discussions. • Rehabilitation success was defined using the following criteria: (i) patients who continued the penile rehabilitation programme and did not switch treatment from PDE5i to other erectile aids, (ii) success was noted in men who had an Expanded Prostate Cancer Index Composite (EPIC) sexual function (SF) score of75% of the patient's baseline EPIC score, and (iii) patients who answered that they achieved adequate erections with a PDE5i. • Logistic regression analysis was used to identify factors associated with treatment participation and its success.• Of 676 patients, 354 (53.2%) men participated in a penile rehabilitation programme. Among 329 rehabilitation participants with available data, 96 (29.2%) had treatment success. • In multivariable regression analysis, African-Americans (odds ratio [OR] 3.47, P0.001), and higher preoperative SF (OR 1.02, P0.001) were associated with participation in rehabilitation. • Higher preoperative PSA concentration (OR 0.50, P = 0.004) and presence of positive surgical margins (OR 0.68, P = 0.042) were found to be independent predictors for non-participation in the rehabilitation. • For rehabilitation outcomes, being older at surgery (OR 0.93, P = 0.001) and adjuvant therapy (OR 0.34, P = 0.047) had a negative association with successful outcome. • There was a trend in the relationship between primary surgeon and rehabilitation success (OR 1.05, P = 0.053)• Those patients who have risk factors, e.g. adverse prostate cancer features, need to be carefully counselled and encouraged to participate in the penile rehabilitation programme. • Clinicians could lead patients toward successful outcomes if appropriate surgical techniques and rehabilitation are provided.

There has been a call in the urological literature for standardized reporting of complications. To use strict criteria aiming to report our complications and other postoperative events in a cohort of men undergoing third-generation prostate cryosurgery.Demographic, clinical and pathological data were collected on men undergoing primary cryosurgery from 2002-2010, excluding those who had received neoadjuvant or adjuvant radiotherapy. Complications and events were broadly defined as any deviation from the expected postoperative course and any subjective complaint expressed during a follow-up visit. Descriptive statistics were generated and compared between groups using chi-squared and rank sum tests as appropriate. Logistic regression analyses were performed to assess the potential predictors of any complication or event.In total, 106 consecutive patients were identified. There were no intra-operative complications or instances of equipment failure. We observed 42 early complications, with 48 delayed and 10 late postoperative events. A total of five (4.7%) patients had persistent urge and/or stress incontinence. Thirty-one patients had International Prostate Symptom Score (IPSS) and bother index scores available before and after surgery; median scores decreased from 7 and 2 to 6 and 1, for IPSS and bother index, respectively. Twenty-four patients had Sexual Health Inventory for Men scores available before surgery and at 2-year follow-up; median scores decreased from 11 to 2. On multivariate analysis, there were no significant associations.Modern cryosurgery is safe, and most of the complications and postoperative events are transient. Erectile function, however, has marked deterioration. We were unable to identify significant risk factors for complications or postoperative events.

To determine the adequacy of T2 prostate cancer (PCa) sub-staging as an independent Predictor of biochemical disease-free survival (bDFS) after radical prostatectomy.The Duke Prostate Center database was queried for patients who underwent radical prostatectomy between 1988 and 2007 and had pT2 PCa, identifying 1990 cases. Prostate-specific antigen (PSA) recurrence was defined as a single value ≥0.2 ng/mL. Kaplan-Meier curves compared differences in bDFS between T2 sub-divisions. Multivariate analysis was performed, adjusting for age, pathological Gleason sum, surgical margin status, preoperative PSA, race, total tumour percentage and prostate weight on biochemical recurrence.The mean age at surgery was 62 years, and 16% of patients were African-American. Median prostate weight was 40 g [interquartile range (IQR) 31-52] and median preoperative PSA was 5.6 (IQR 4.2-7.8). Pathological Gleason score was ≤6 in 57%, 7 in 38%, and ≥8 in 5%; pathological T stage distribution was 18% T2a, 6% T2b, and 76% T2c; and percentage tumour involvement was ≤5% in 43%, between 5.1 and 10% in 24%, between 10.1 and 15% in 10%, and15% in 19%. 366 (18.4%) patients had a biochemical recurrence after a median of 4.6 years (IQR 2.1-8.2) follow-up. bDFS was significantly (P= 0.006) higher for pT2a disease than for pT2b and pT2c, which were comparable. Adjusting for demographic and other pathological variables, T2 sub-divisions lost statistical significance.Pathological T2a prostate cancer has significantly higher bDFS than the pT2b or pT2c sub-groups in univariate but not multivariate analyses. Different pathological features should be explored to create more meaningfully predictive pathological T2 sub-divisions.