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INTRODUCTION AND OBJECTIVE:In efforts to judiciously utilize resources and contain cost, there has been increasing efforts to reduce postoperative length of stay, resulting in several groups promot...

INTRODUCTION AND OBJECTIVE:The management of patients with high risk non-muscle invasive urothelial carcinoma (UC) is complex due to the biological heterogeneity of the disease. The management of m...

INTRODUCTION AND OBJECTIVE:Narcotics are prescribed excessively following surgery and may lead to persistent opioid use. As many urologic oncology procedures are performed minimally invasively, an ...

INTRODUCTION AND OBJECTIVE:The choice between active surveillance (AS) and surgical treatment for patients with newly diagnosed low risk malignancies is complex. To inform this nuanced decision, we...

INTRODUCTION AND OBJECTIVE:Cystic renal cell carcinomas (cRCC) are suggested to be clinically indolent. As such, a distinct pathologic staging category for these lesions was recently proposed. Thes...

INTRODUCTION AND OBJECTIVE:Renal mass biopsy (RMB) has not been adopted widely by urologists for the evaluation of small renal mass (SRM) before considering surgical intervention due to concerns fo...

INTRODUCTION AND OBJECTIVES:Level 1 evidence shows that mTOR inhibition is associated with clinically significant reductions in tumor size in angiomyolipomas (AMLs) associated with Tuberous Scleros...

INTRODUCTION AND OBJECTIVES:Most recent AUA guidelines suggest that an expected drop of estimated glomerular filtration rate (eGFR) below 45 ml/min/1.733 upon radical nephrectomy (RN) should guide ...

INTRODUCTION AND OBJECTIVES:The AIM and ReM were recently introduced to objectify fusion biopsy deliverables. The AIM metric affords a quantifiable assessment of when US/MRI fusion targeted biopsy ...

INTRODUCTION AND OBJECTIVE:Concern for discordance between endoscopic evaluation and final pathology drives current clinical management of patients deemed appropriate candidates for radical cystect...

INTRODUCTION AND OBJECTIVES: Transrectal ultrasoundguided prostate biopsy (TRUS-B) is the gold standard for prostate cancer (CaP) diagnosis. mpMRI/US fusion targeted biopsy (TB) has emerged as a technique to optimize the procedure. The ideal prostate biopsy would: (1) identify all non-low risk CaP with greater sensitivity than TRUS-B; (2) eliminate the need for unnecessary sampling. Using our institutional dataset and the available literature, the objective of the present study was to define metrics that more accurately demonstrate the deliverables of TB and facilitate meaningful data comparisons. METHODS: Patients (pts) with indications for TRUS-B having identified prostate lesions (PIRADS 3-5) on mpMRI were included. The UroNav System (Invivo) was used to obtain 1-4 TBs of each targeted lesion. All men underwent concurrent 12-core TRUS-B. Actionable intelligence metric (AIM) was defined as all pts with higher Gleason score (GS) on TB (minimum GS 3+41⁄47) relative to TRUS-B O total pts with GS 3+41⁄47 CaP (i.e. % for whom TB offered actionable data over TRUS-B). Reduction metric (RM) was defined as 1 [all pts with higher GS on TRUS-B (minimum GS 3+41⁄47) relative to TB O total pts undergoing biopsy] (i.e. % who could have foregone TRUS-B). Cohort metrics were compared to previously published data. RESULTS: 149 pts (mean age 64 7.4y, PSA 9.1 8.6 ng/ml, and prostate volume 53.6 34.2 cc) were examined: 21 (14.1%) biopsy naive men (G1), 74 (49.7%) men with prior negative TRUS-B (G2), and 54 (36.2%) men with prior positive TRUS-B on an active surveillance (AS) protocol (G3). Overall cancer detection rate was 90/149 (60.4%): 12/21 (57%) for G1, 33/74 (44.6%) for G2, and 45/54 (83.3%) for G3. AIM and RM for the entire cohort was 22.6% and 78.5%; 25% and 81.0% for G1, 28.6% and 81.1% for G2, and 12.0% and 72.2% for G3. These findings are similar to previously published cohorts in which the AIM and RM are 13.6% and 95.5% and 23.6% and 93.6% for G1 and G2, respectively. AIM and RM for men on AS is not calculable from the currently published literature. CONCLUSIONS: TB harbors potential for improvement over TRUS-B; however, deliverables of this costly technology must be outlined. We define two metrics, AIM and RM, for use in future reports to help quantify, communicate, and compare the added value of TB technology. At present, 12-core TRUS-B remains a necessary adjunct to TB, particularly in the AS setting.

INTRODUCTION AND OBJECTIVES: Recent reports suggest that patients who experience de novo chronic kidney disease (CKD) due to surgical removal of nephrons (CKD-S) differ from patients with pre-existing CKD who undergo similar procedures (CKD-M/S). Here, we evaluate survival in these groups following kidney surgery. METHODS: We queried our prospective Kidney Cancer Database for all patients who underwent radical or partial nephrectomy during January 1990 to July 2015 where survival data was available. New baseline GFR (nbGFR) was calculated 30 days after surgery. We divided the cohort into 3 groups: no post-op CKD (nbGFR >60); new onset post-op CKD (CKD-S 1⁄4nbGFR 45 (mild). Kaplan-Meier estimates were used to assess overall survival (OS) and cancer specific survival (CCS). Cox proportional hazards model was fitted while controlling for age, gender and comorbidities. RESULTS: 947 patients were included in the study. No CKD, new onset CKD-S and persistent CKD-M/S groups included 525 (55.4%), 267 (28.19%) and 155 (16.37%) patients respectively. 67.27% of the patients were male and 65.8% had measured comorbidities. CKD-M/S had a lower nbGFR compared with CKD-S and no CKD (40 vs. 49 vs. 81, p

muscle invasive bladder cancer. Midline fascial defects including wound dehiscence and incisional hernia are morbid postoperative events. Our objective was to identify predisposing factors for midline fascial defects in this population with multiple morbidities. METHODS: The records of all patients who underwent cystectomy and ileal conduit between 1994 and 2011 were reviewed. Wound dehiscence was defined as a midline separation of the fascia requiring operative reclosure. Post-operative incisional hernia was defined as a palpable fascial defect on follow-up physical exam. Univariate and multivariate logistic regression models of factors that may be predictive of midline fascial defect were conducted. RESULTS: A total of 963 patients were identified with a median age of 71 years and median follow-up of 15.8 months (range, 0.23 e 188.85 months). Ninety-four patients (9.8%) developed a midline fascial defect (51 wound dehiscences, 43 incisional hernias). A multivariate logistic regression model for midline fascial defects demonstrated that steroid usage and post-operative wound infections were independent predictors. Fewer than expected wound events occurred in patients who received neoadjuvant chemotherapy. In the wound dehiscence subgroup, post-operative wound infection was the only significant factor (p1⁄4

diversion (UD). Enhanced recovery after surgery (ERAS) protocols focus on avoiding bowel preparation and nasogastric tube, early feeding nonnarcotic pain management and the use of cholinergic and mu-opioid antagonists. We evaluated our ERAS patients for GI postoperative course and complications in the first 30 days after RC and compared them to traditional method of postoperative care. METHODS: Under IRB approval, 241 patients who underwent open RC and UD using our ERAS protocol from 5.2012 to 10.2014 were selected for the study. We used our bladder cancer database to find a matched cohort of RC controls with traditional (non-ERAS) protocol from 2003 to 4.2012. Bowel activity in the postoperative period as well as GI complications of the first 30 days were compared. RESULTS: A total of 145 patients on ERAS arm and 144 matched controls were included in the study. Median time from surgery to first bowel movement was 2 days in ERAS and 5 days in controls (p

METHODS: We performed a multi-institutional retrospective review of 1240 patients undergoing PN (open or laparoscopic) for localized renal malignancy between from 2002 to 2013. Recurrencefree survival was estimated using the Kaplan-Meier method and evaluated as a function of PSM with log-rank test and Cox proportional hazards models adjusting for tumor size, grade, histology, pathologic stage, focality, and laterality. Site of recurrence (local or distant) as a function of PSM was tested with Fisher’s exact test. RESULTS: A total of 97 (8%) patients had PSM. PSM was unrelated to tumor size, grade, histology, pathologic stage, focality or laterality (all P > 0.05). A total of 69 (6%) patients developed recurrence over a median follow up of 33 months (interquartile range [IQR] 1⁄4 1557). Of these, 42 (61%) were local and 27 (39%) were distant recurrences. The median time to recurrence was 19 months (IQR 1⁄4 1235). On univariable analysis, PSM was associated with higher recurrence rates (Figure, P 1⁄4 0.002). On multivariable analysis, PSM remained associated with higher recurrence rates (hazard ratio 1⁄4 2.91, 95% confidence interval 1⁄4 1.25-6.78, P 1⁄4 0.013). PSM was not associated with site of recurrence (P 1⁄4 0.52). CONCLUSIONS: PSM is associated with an increased risk of recurrence after PN. Urologist should strive to obtain negative surgical margins in order to maximize disease-free survival. For patients with PSM, close follow-up is advisable given their higher risk of disease recurrence.

muscle invasive bladder cancer. Midline fascial defects including wound dehiscence and incisional hernia are morbid postoperative events. Our objective was to identify predisposing factors for midline fascial defects in this population with multiple morbidities. METHODS: The records of all patients who underwent cystectomy and ileal conduit between 1994 and 2011 were reviewed. Wound dehiscence was defined as a midline separation of the fascia requiring operative reclosure. Post-operative incisional hernia was defined as a palpable fascial defect on follow-up physical exam. Univariate and multivariate logistic regression models of factors that may be predictive of midline fascial defect were conducted. RESULTS: A total of 963 patients were identified with a median age of 71 years and median follow-up of 15.8 months (range, 0.23 e 188.85 months). Ninety-four patients (9.8%) developed a midline fascial defect (51 wound dehiscences, 43 incisional hernias). A multivariate logistic regression model for midline fascial defects demonstrated that steroid usage and post-operative wound infections were independent predictors. Fewer than expected wound events occurred in patients who received neoadjuvant chemotherapy. In the wound dehiscence subgroup, post-operative wound infection was the only significant factor (p1⁄4

RESULTS: Within the NCDB, of 59,652 patients with testicular cancer, 5475 (9.2%) underwent RPLND. The utilization of RPLND varied significantly different between the types of facility across all stages of non-seminoma (Figure) with the highest rates of use recorded in academic centers (all p

PURPOSE To evaluate the antitumor activity of 96-hour paclitaxel and daily oral estramustine phosphate (EMP) in patients with metastatic hormone-refractory prostate cancer (HRPC). PATIENTS AND METHODS Thirty-four patients with adenocarcinoma of the prostate that progressed after one or more hormonal therapies and a trial of antiandrogen withdrawal were enrolled onto this phase II trial. Patients received paclitaxel 120 mg/m2 by 96-hour intravenous (i.v.) infusion on days 1 through 4 of each 21-day cycle, together with daily oral EMP 600 mg/m2/d, continuously. RESULTS Four of nine patients with measurable disease had objective responses (one complete response [CR] and three partial responses [PRs]) in liver (two patients) or nodes (two patients) of 2, 6, 8, and 20 months' duration. Of 25 assessable patients with metastases limited to bone, 14 had a > or = 50% decline in pretreatment prostate-specific antigen (PSA) level sustained for at least 6 weeks and seven had a > or = 80% decline. Overall, 17 of 32 patients (53.1%) with elevated pretreatment PSA levels had a > or = 50% decline of PSA and nine (28.1%) had a > or = 80% decrease. The main toxicities (> or = grade 2) were nausea, fluid retention, and fatigue, which occurred in 33%, 33%, and 24.2% of patients. Median time to progression, based on increasing PSA level and other clinical criteria, was 22.5 weeks. The estimated median overall survival time is 69 weeks. CONCLUSION The combination of EMP and 96-hour paclitaxel is an active regimen for patients with HRPC. These results further support the therapeutic strategy of combining agents that impair microtubule function by complementary mechanisms.