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Objectives To compare perioperative outcomes between open conversion and planned open surgical approach and to investigate trends. Materials and Methods The National Cancer Database (NCDB) was queried for cT1 and cT2 RCC treated by radical (RN) or partial (PN) nephrectomy between 2010 and 2016. We retrospectively analyzed patient demographics, clinical tumor characteristics, and perioperative outcomes between unplanned open conversion and planned open approaches for RN and PN. Results In total, 152,919 patients underwent RN or PN for cT1 or cT2 RCC over the 7-year span. The rate of unplanned open conversion from MIS was 3.9% overall, remaining lowest for cT1 PN (2.7%) and highest for cT2 RN (5.9%). Cases of open conversion tended to have higher rate of upstaged disease. When comparing open conversion to a planned open case, there was no difference in the length of post-operative hospitalization. On logistic regression, unplanned open conversion from MIS was associated with higher odds of positive margin for RN but not for PN. Increased odds of 30-day's readmission were associated with unplanned open conversion from MIS in the setting of cT1 PN only. Conclusion When compared to a planned open approach, conversion to open from MIS does not affect length of hospital stay but is associated with higher odds of positive surgical margins for RN and higher odds of 30-day's readmission for cT1 PN. Advanced pathologic stage is associated with an open conversion, likely relating to increased tumor complexity. These findings should be considered preoperatively when determining the best surgical approach.

Purpose: Previous studies have noted increased utilization of perioperative chemotherapy over time. The goal of this study was to determine trends in perioperative chemotherapy use within a contemporary population. Materials and Methods: The National Cancer Database was queried for patients diagnosed with cT2-4N0M0 urothelial muscle invasive bladder cancer from 2011 to 2015 and underwent subsequent radical cystectomy. We retrospectively analyzed factors associated with perioperative chemotherapy and evaluated overall treatment trends in the use of neoadjuvant and adjuvant chemotherapy. Linear regression, logistic regression, Cox regression, and Kaplan–Meier analysis were performed. Results: In total, 7,101 patients met inclusion criteria for analysis. The use of perioperative chemotherapy increased from 46.4% in 2011 to 57.2% in 2015 (p=0.003). Neoadjuvant chemotherapy use increased from 22.9% to 32.3% (p=0.007) over the time period analyzed, while adjuvant chemotherapy use experienced no significant change (23.5% to 24.9%, p=0.182). Logistic regression demonstrated that increased age and Charlson Comorbidity Index were predictors of not receiving chemotherapy (p

Background: Sarcomatoid renal cell carcinoma (sRCC) is thought to arise by epithelial to mesenchymal transition (EMT) of the parental tumor in diverse RCC including clear cell RCC (ccRCC). sRCC is also known to be highly immunogenic and also express high levels of inflammatory pathway genes. Cells undergoing EMT and immune cells can have reciprocal feedback on each other; however, the role of such crosstalk in sRCC is unknown. Here, we use single cell spatial transcriptomics to evaluate the heterogeneity of EMT within sRCC in correlation with the immune microenvironment and in-vitro studies to explore mechanisms of crosstalk. Methods: A sRCC nephrectomy specimen was subjected to single cell spatial transcriptomics of 1000 mRNA targets (NanoString CosMX). Semi-supervised clustering was performed and cell types were assigned by reference to single cell RNAseq data and then mapped spatially. Differential gene expression and cell to cell distance analysis was performed. In-vitro assays included treatment of 786-O and Caki-1 ccRCC lines with recombinant SPP1 and protein and mRNA analysis. Results: Histopathologic evaluation revealed a ccRCC zone, a transition zone (tz) between the ccRCC and sRCC in which the ccRCC cells gained an increased mesenchymal morphology, and a well-developed sRCC zone. Transcriptomic data revealed four distinct tumor cell populations: a ccRCC, a tzRCC, and two sRCC populations. Importantly, a subset of the histologically-categorized ccRCC had a tzRCC transcriptional signature, demonstrating this signature is identifiable prior to development of morphologic features of sRCC. FZD4, a factor that may function in preventing EMT, was uniquely expressed on ccRCC and lost in tzRCC and sRCC cells. CCL20, a promoter of macrophage recruitment, was highly expressed in tzRCC. Distance analysis showed macrophages were highly spatially correlated with tzRCC and sRCC cells. Macrophages near tzRCC differentially expressed SPP1. In-vitro treatment of ccRCC cells with recombinant SPP1 led to induction of EMT and further upregulation of CCL20 expression. Conclusion: We report a unique tumor cell population characterized by ccRCC morphology but harboring a transcriptome suggestive of progression towards sRCC. This provides rationale for the development of a novel molecular signature to subclassify ccRCC. We identified FZD4, CCL20 and SPP1 as key genes in the transition of ccRCC to sRCC which may mediate crosstalk between RCC cells and macrophages, with potential for therapeutic targets. Citation Format: Allison May, Claire Williams, Stephanie The, Sean Kim, Nathan Schurman, Greg Shelley, Tyler Robinson, Simpa Salami, Rohit Mehra, Aaron Udager, Evan Keller. Spatial analysis of the immune microenvironment and tumor cell transition in sarcomatoid renal cell carcinoma. [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 4700.

INTRODUCTION AND OBJECTIVE:Minimally invasive (MI) techniques for nephrectomy with tumor thrombus remain understudied. We compared a traditional open approach to a MI approach with respect to short...

Background: Renal masses can be surgically treated by partial nephrectomy (PN) or radical nephrectomy (RN); however, in 2009 guidelines recommended PN as the standard of care for cT1a renal masses. Objective: To evaluate national trends of surgically appropriate patients using the National Cancer Database (NCDB) for utilization of PN focusing on guideline release, evaluating underlying health disparity. Methods: We identified 99,035 patients from 2004–2015 that underwent surgical resection of cT1a renal masses. We evaluated treatment proportions over time of patients treated with PN or RN. Logistic regression was utilized for multivariable analysis. Results: PN increased from 40.2% in 2004 to 71.3% in 2015 (p

Partial nephrectomy is the mainstay of treatment for localized kidney cancer. A proportion of patients are upstaged post-operatively to locally advanced disease (pT3a). We aimed to identify the incidence of upstaging to pT3a during partial nephrectomy and its relationship to a robotic approach. The National Cancer Database was queried for patients diagnosed with cT1M0 disease between 2010 and 2015 who underwent an open or robotic partial nephrectomy with final stage pT1–3a. Our primary outcome was rate of upstaging to pT3a in patients undergoing partial nephrectomy and secondary outcomes were stage migration, rate of positive margins, and overall survival (OS). The relationship between open and robotic surgery was examined. Logistical regression and Kaplan–Meier analyses were performed. Of 68,976 patients identified, 5.9% of patients were upstaged from cT1 to pT3a post-operatively. The incidence of upstaging to pT3a disease has increased from 5.7% in 2010 to 6.9% in 2015. Similarly, the proportion of patients undergoing a robotic approach is also increasing (31.6–64.4%); however, a robotic approach is not associated with pT3a upstaging on multivariable analysis. The probability of being upstaged was significantly proportional to increasing tumor size (OR 2.634–11.641, p

Our objective was to determine perioperative variables associated with 30-day readmission to the index operative hospital after radical cystectomy for bladder cancer and subsequent survival outcomes. Retrospective cohort study utilizing the United States National Cancer Database from 2004–2015. All clinical stages undergoing radical cystectomy were analyzed. Exclusion criteria included clinical suspicion of nodal disease, metastasis, or preoperative radiation therapy. Multivariable logistic regression was used for 30-day readmission risk to the index hospital. Kaplan–Meier analysis and multivariable Cox regressions were used for survival outcomes. 31,147 patients were identified and stratified by 30-day readmission (n = 2628) or no readmission (n = 28,519). Thirty-day readmission to the index surgery hospital was 8.4%. Groups were comparable in terms of age, gender, race, income, facility type, insurance, length of hospital stay, and pathologic stage. There were significantly more patients with higher Charlson comorbidity score in the readmission cohort. On logistic regression analysis, increasing Charlson score was the only predictor of 30-day readmission (OR 1.39–1.73, p

Objective Treatment of renal cell carcinoma has evolved with emphasis on nephron preservation for small renal masses. Our objective was to evaluate the proportions of treatment types for octogenarians with clinical stage 1 renal cell carcinoma. Materials and Methods The National Cancer Database was analyzed from 2004 to 2015. Patients with clinical stage 1, tumor size ≤ 7 cm, and age 80–89 years old were compared to a younger control arm of patients ≤ 70 years old. Treatment modality was categorized as radical nephrectomy (RN), partial nephrectomy (PN), percutaneous ablative therapy (PAT), and no treatment (NT). Primary outcome was treatment utilization over time using estimated annual percentage change (EAPC). Secondary outcomes included logistic regression for 30 day readmission after treatment and any definitive tumor treatment choice. Results 18,903 octogenarians were identified and compared to a control of 142,179 patients ≤ 70 years old. Overall, NT (36%) was the most common modality for octogenarians while PN (44.8%) was most common for the control arm. Using EAPC for octogenarians, we found increases for PAT (7.1%), PN (2.8%), and NT (1.6%) but a decrease for RN (−4.6%). EAPC for the younger cohort noted increases for PAT (6.8%), PN (5.4%), and NT (4.4%) but a decrease for RN (−5.5%). Conclusion For octogenarians with stage 1 renal cell carcinoma, minimally invasive treatments are increasingly utilized, while RN is decreasing. Compared to a younger cohort, a greater proportion of octogenarians are receiving NT. These findings remain encouraging for appropriate treatment of localized disease in patients with advanced age.

Introduction Upper tract urothelial carcinomas (UTUCs) account for 5% to 10% of urothelial cancers. The phenomenon of stage migration in tumors has been evident with increased use and higher resolution of cross-sectional imaging. Using the National Cancer Database, we analyzed trends in stage at presentation and overall survival for UTUCs. Patients and Methods We analyzed UTUCs in the renal pelvis or ureter from 2004 to 2016. Pathologic tumor stage data were available for 71.3% of patients and clinical tumor staging were available for 28.7% of patients. Five-year overall survival was analyzed comparing patients between 2004-2007 and 2008-2011. Tumor stage was categorized as early (0-1), intermediate (2-3), or late (4) for survival analyses. Linear regression and Kaplan-Meier analyses were utilized. Results A total of 37,210 renal pelvic and 23,200 ureteral origin UTUC cases were evaluated. Stage migration toward stage 0 and stage 4 was observed. There was a significant increase in proportion of stage 0 Ta/Tis (22.8%-33.4%, R2 = 0.86, P Conclusion There is a stage migration toward stage 0 and stage 4 disease for UTUC. Five-year survival data from 2004 to 2011 remained stable across early, intermediate, and late stage groups.

Squamous cell carcinoma (SCC) of the bladder is a rare, aggressive malignancy. Unlike urothelial cell carcinoma, SCC is resistant to chemotherapy and guidelines recommend radical cystectomy (RC) without neoadjuvant chemotherapy (NAC). We aimed to evaluate the current management and survival of patients with invasive SCC treated with or without NAC. 671 patients with invasive SCC bladder cancer from 2004 to 2015 in the National Cancer Data Base were identified. Patients were stratified by treatment with RC alone or NAC prior to RC (NAC + RC). Survival analysis was performed with Kaplan–Meier and Cox regression. Secondary outcomes included length of stay and readmission. Of 671 patients, 92.8% were treated with RC alone and 7.2% with NAC + RC. Cox regression for mortality was performed including age, Charlson score, clinical stage, and NAC. Increased risk of mortality was noted with increasing age (OR 1.01, p = 0.023) and Charlson score of 1–3 (HR 1.58–1.68, p

Objective: Our objective was to analyze patterns of treatment for metastatic renal cell carcinoma (mRCC) (no treatment (NT), cytoreductive nephrectomy only (CN), systemic therapy only (ST), and both systemic and cytoreductive (ST+CN)), and correlate them with racial or socioeconomic factors. Materials and Methods: Cases of mRCC from 2004–2015 were selected from the National Cancer Database. Our primary outcome was the temporal trend of treatment types. Secondary outcomes included the association of treatment with racial and socioeconomic factors. Logistical regression was performed. Results: In total, 40,372 patients with mRCC were identified. Treatment modalities included 37.0% NT, 13.9% CN only, 31.6% ST only and 17.5% ST+CN. From 2004–2015, NT decreased (53.4 vs. 32.1%, p < 0.001), CN alone decreased (18.1 vs. 12.1%, p < 0.001), ST alone increased (18.1 vs. 36.7%, p < 0.001) and ST+CN increased (10.3 vs. 19.1%, p < 0.001). On logistical regression, we found non-white races (odds ratio 1.29–1.73, p < 0.001), low-volume centers (hazard ratio (HR) 1.18, p < 0.001), no insurance (HR 2.29, p < 0.001) and low income (HR 1.24, p < 0.001) increased the likelihood of receiving NT. Conclusion: More patients are receiving ST and ST+CN; however, racial and socioeconomic factors may affect the treatment patterns for mRCC, and the underlying cause of these health disparities is unknown. Level of Evidence: 2c6

In recent decades, there has been significant growth in the understanding of the immune system and its role in cancer. The recent introduction of checkpoint inhibitors has drastically changed the treatment landscape of cancer as a whole. In this review, we discuss the major clinical developments of immunotherapy in urologic specific cancers, as well as address future directions in this field.

INTRODUCTION AND OBJECTIVE:Advanced penile cancer is associated with a poor prognosis; therefore, providing patients with realistic expectations, addressing goals of care and offering palliative th...

INTRODUCTION AND OBJECTIVE:Renal cell carcinoma extending into the inferior vena cava is classified as T3b or T3c and represents an aggressive disease with variable prognosis. Surgical treatment is...

To review the United States National Cancer Database (NCDB) from 2004 to 2015 and analyze survival outcomes of invasive non-urachal adenocarcinoma based on treatment modality. The NCDB 2004–2015 bladder dataset was queried for adenocarcinoma histology, excluding urachal variant, and limited to patients with clinical stage T2–T4 disease. Treatment modality was categorized as no treatment, cystectomy (partial or radical), external beam radiation therapy (EBRT), or EBRT plus cystectomy. Our primary outcome was overall survival. Cox regression (CR) and Kaplan–Meier (KM) analysis were performed. 851 patients were identified with invasive (cT2–T4) adenocarcinoma of the bladder. Treatment modalities included 398 (47.8%) no treatment, 298 (35.8%) cystectomy, 124 (14.9%) EBRT, and 31 (3.7%) EBRT plus cystectomy. On KM analysis excluding those with metastatic disease, the 5-year survival was significantly better (p

Background: The appropriate intervention for hip subluxation or dislocation in children affected by cerebral palsy (CP) remains controversial. The purpose of this retrospective study was to report radiographic and clinical outcomes following isolated femoral varus derotational osteotomy (VDRO) in children with CP hip dysplasia. Risk factors for resubluxation and avascular necrosis (AVN) were also examined. Methods: A cohort of 100 patients (199 hips) with CP treated with isolated VDRO between 2003 and 2009 was reviewed. All but 1 patient received bilateral surgery. Patients were followed for an average of 5.4 years (range, 1.03 to 10.20 y). Anteroposterior pelvic radiographs were used to assess migration percentage (MP), Shenton’s line, and presence of AVN. Resubluxation was defined as a postoperative break in Shenton’s line. Radiographic outcomes and risk analysis was performed in the 91 subjects (179 hips) with radiographic follow-up >1 year. Results: Significant improvement was observed in MP, and all hips had a reconstituted Shenton’s line following surgery. Over the course of follow-up, 16% of hips were noted to have a repeat break in Shenton’s line. Univariate risk analysis showed preoperative MP, Gross Motor Function Classification System (GMFCS) level, and age at surgery were risk factors for a recurrent line break. Preoperative MP and GMFCS level were found to be predictors of resubluxation in multivariate analysis. AVN was detected in 10 hips (5.7%). GMFCS level V patients were more at risk for resubluxation, but less at risk for AVN when compared with ambulatory (GMFCS I/II/II) patients and GMFCS level IV patients. Conclusions: Performing a VDRO without additional procedures provided a stable and concentrically reduced hip joint in this population of children with CP. Attention should be paid to initial ambulatory status during the postoperative period. Concomitant procedures such as pelvic osteotomy should be considered for patients of GMFCS level IV and V, as these patients were more at risk for recurrent subluxation. Level of Evidence: Level III—retrospective comparative study.

To characterize the treatment trends and outcomes in clinical stage T1 penile cancer using the National Cancer Database (NCDB).The National Cancer Database was queried for all men with cT1 penile cancer from 2004 to 2015. Patients were categorized as cT1a or cT1b. Treatment was categorized as no treatment, local therapy (including penile sparing therapies), partial penectomy, or radical penectomy. Trends in treatment were analyzed over time and in correlation with stage and demographic variables. Stage and treatment type were evaluated in respect to pathological outcomes and survival.A total of 2,484 men were identified with cT1 penile cancer, 90.1% of which had cT1a disease. The most common treatments were local therapy for cT1a and partial penectomy for cT1b. Over the time period studied, use of local therapy decreased while use of partial or radical penectomy increased. Patients treated at low volume facilities were more likely to undergo no treatment (8.0% vs. 6.5% in high volume) or local therapy (49.9% vs. 41.5% in high volume, P0.001). Local therapy was associated with increased risk of positive margin (odds ratio 4.7, P0.001) and positive margin was associated with a trend toward decreased overall survival (P = 0.07).In the past decade, there has been decreased use of local therapy and increased use of partial or radical penectomy in cT1 penile cancer. Men treated at low volume facilities are more likely to be treated with local therapy which is associated with increased rates of positive margins and may also be associated with a trend toward decreased overall survival. Centralization of care in T1 penile cancer may lead to improved outcomes.

To evaluate the overall survival and pathologic downstaging effect of neoadjuvant chemotherapy for upper tract urothelial cell carcinoma.The National Cancer Database (NCDB) was queried for patients with stage II-IV upper tract urothelial cell carcinoma undergoing definitive surgical resection (nephroureterectomy) from 2004-2015. Patients with metastatic disease were excluded. Cohorts were stratified by receipt of neoadjuvant chemotherapy (NAC). Kaplan-Meier analysis and Cox regression were used to evaluate overall survival. Logistic regression was used to predict the odds of pathologic downstaging to non-invasive disease (pT2). Propensity score matched analysis was performed between groups.A total of 3634 patients were identified with non-metastatic stage II-IV disease undergoing surgical resection; 3364 received no chemotherapy and 270 received NAC. Patients undergoing NAC had a 10.9% rate of downstaging to non-invasive disease (OR 6.35, p0.001). Moreover, on Kaplan-Meier analysis, median survival was 27.3 months and 44.8 months for no chemotherapy versus NAC, respectively (log-rank, p = 0.001). Cox regression for death also revealed benefits for receiving NAC (HR 0.67, p0.001). Findings were confirmed on propensity score matching (532 matched patients). After matching, Cox regression for death noted improvement with neoadjuvant as compared to no chemotherapy (HR 0.61, p0.001).Neoadjuvant chemotherapy increases likelihood of downstaging to non-invasive disease in patients with upper tract urothelial cell carcinoma. Chemotherapy also provides an overall survival benefit in patients undergoing nephroureterectomy.

The use of lymph node density (LND) as a predictor of survival outcomes has been studied with urothelial carcinoma of the bladder. Similar results can be postulated to upper tract urothelial carcinoma (UTUC). This study aims to determine the overall survival of patients with lymph node positive UTUC based on LND, utilizing the National Cancer Database (NCDB).Data was derived from NCDB Participant User Kidney Dataset using the histology code 'transitional cell carcinoma', utilizing pN+ patients from 2004-2015. LND was calculated as number of positive nodes divided by total number of nodes removed. Patients were stratified by traditional AJCC pN stage and compared to LND groups (30%, ≥ 30%). Primary outcome was overall survival. Kaplan-Meier and Cox regression analyses were performed.A total of 2049 patients were identified (pN1 = 1022, pN2 = 1027; LND30% = 370, ≥ 30% = 1679). Mean LND was 71%. Cox regression for mortality using pN stage was not significant (p = 0.11); however, Cox regression for mortality using LND group noted significantly worsened survival with LND ≥ 30% (HR 1.54, p = 0.001). Kaplan Meier analysis for overall survival at 2 years showed no difference between pN1 and pN2 stages (35.3% versus 34.1%; log rank p = 0.37). Kaplan Meier analysis for overall survival at 2 years revealed significant difference between LND groups (LND30%, 47.3% versus LND ≥ 30%, 32.0%; log rank p0.001).LND provides improved prognostic information regarding overall survival, compared to traditional AJCC pN staging. Future studies need to evaluate LND to improve prognostic understanding of lymph node positive UTUC.

INTRODUCTION AND OBJECTIVES:Standard of care treatment based on national guidelines for men with clinically localized high risk prostate cancer includes radical prostatectomy (RP) or external beam ...

Background Renal cell carcinoma (RCC) most commonly afflicts older patients while those 40 years old or younger represent an uncommon population. We aim to describe the tumor characteristics and treatment patterns for young kidney cancer patients utilizing the National Cancer Database. Methods The National Cancer Database Participant User File for RCC was queried from 2004 to 2016. Demographics and treatment trends were analyzed and compared between a young cohort, those aged 40 and younger vs. a conventional cohort, those older than 40. Pathology analyzed included clear cell, papillary, chromophobe, RCC not otherwise specified, and miscellaneous uncategorized. Subanalysis was performed for patients with localized disease and treatment type. Results Amongst the 514,879 patients diagnosed with RCC, 4.7% were ≤40 years old. RCC for individuals ≤40 has a higher proportion of female gender, non-Caucasian race, and chromophobe pathology, relative to the conventional cohort. Younger patients more often presented with cT1 disease with decreased rates of metastasis. Risk of 30-day readmission after surgery was similar between cohorts. For patients with cT1-2N0M0 disease, there was a decreasing rate of radical nephrectomy and increasing rate of partial nephrectomy; however, the conventional cohort had an increasing rate of percutaneous ablation while this remained stable in the younger cohort. Conclusion Young RCC patients had a higher proportion of female gender, chromophobe histology, and favorable tumor characteristics. Partial nephrectomy has seen a dramatic increase in application regardless of age while percutaneous ablation increased only in the conventional cohort.

To analyze national trends using the National Cancer Database (NCDB) in use of androgen deprivation therapy (ADT), outside of standard of care, in patients with very low risk prostate cancer.We identified 52,797 men in the NCDB from 2010 to 2015 diagnosed with very low risk prostate cancer as defined (cT1cM0, PSA10, Gleason ≤6,3 biopsy cores positive). We evaluated the treatment trends and the proportion of men treated with ADT based on race, income, insurance status, treatment facility volume, and Charlson comorbidity.From 2010 to 2015, prevalence of primary ADT use in patients with very low risk prostate cancer remained 0.7%. Patients treated at low-volume facilities were more likely to receive primary ADT (hazard ratio [HR] 1.29, P.001) as were black patients (HR 1.47, P.001). When evaluated over time, the proportion of men treated with primary ADT who were white decreased while the proportion of men who were black increased.The use of primary ADT in men with very low risk prostate cancer has not changed over time, and may be over utilized, particularly among black men and those treated at low-volume facilities.

Conservative management of penetrating renal trauma is emerging, with data originating from centers with variable level of trauma care. This study reviews the outcomes of renal salvage after penetrating trauma at a level I trauma center.An institutional review board approved trauma registry at Saint Louis University Hospital was retrospectively analyzed, for patients with penetrating renal trauma from 2009 to 2014. Patients were divided into nephrectomy group (NG) or non-nephrectomy group (non-NG), and compared. A multi-variable analysis was performed to determine predictors of nephrectomy, with cross validation to evaluate the performance of the multi-variable model. Data was analyzed using R version 3.3.2. A p value of0.05 was considered as significant.A total of 121 patients were identified with penetrating renal trauma. Gunshot injury was the leading cause of injury (87%). Eighteen (15%) patients required nephrectomy. The overall mean injury severity score (ISS). was 20. High grade (grade 4-5) renal injuries were noted in 41 patients (34%). Among these, 14 patients (34%) underwent a nephrectomy, while 27 patients (66%) were managed conservatively to salvage renal units. CT grade of renal injury was the only predictor of nephrectomy, on multi-variable analysis (OR 17.09 CI 2.75-105.99, p = 0.002). CT grade of injury and injury severity score were predictors of endoscopic intervention on a sub group analysis of non-NG.CT grade of injury predicts nephrectomy after penetrating renal trauma. Conservative management is a feasible option in penetrating renal trauma even with a higher grade of injury.

This study demonstrates the advantages of combining remote sensing with field data in landslide investigations and provides improved data on the structural geology and its influence on slope movements at Downie Slide, a large landslide located in southeastern British Columbia, Canada. The geomorphology of the Downie Slide was studied using airborne LiDAR in a GIS environment to provide new insights on the landslide displacement mechanism. Surface and underground areas of the slide were compared and contrasted using terrestrial laser scanning and photogrammetry. Six joint sets were identified. Some structures and domain boundaries were found to be pervasive throughout the slide. A correlation between slope deformation, and large-scale structural and damage features was made and 12 structural domains defined within the landslide. Large secondary retrogressive-failures were identified for the head scarp and retrogression of the northern boundary, increasing the overall area of slide material by ~ 1 km2.

Open simple prostatectomy is the mainstay treatment for obstructive urinary symptoms due to benign prostate enlargement, failing medical and/or transurethral resection therapies. Due to widespread utilization of robot-assisted techniques for radical prostatectomy, robot-assisted simple prostatectomy (RASP) has gained similar popularity. Availability of dual console on newer robotic platforms has improved the ability to engage the 4th arm, providing dynamic use during the operation. In this case report we describe the use of dynamic retraction for a 59-year-old male who underwent RASP.

Current management of high-grade blunt renal trauma favors a nonoperative approach when possible. We performed a retrospective study of high grade blunt renal injuries at our level I trauma center to determine the indications and success of nonoperative management (NOM). 47 patients with blunt grade IV or V injuries were identified between October 2004 and December 2013. Immediate operative patients (IO) were compared to nonoperatively managed (NOM). Of the 47 patients, 3 (6.4%) were IO and 44 (95.6%) NOM. IO patients had a higher heart rate on admission, 133 versus 100 in NOM (P=0.01). IO patients had a higher rate of injury to the renal vein or artery (100%) compared to NOM group (18%) (P=0.01). NOM failed in 3 of 44 patients (6.8%). Two required nonemergent nephrectomy and one required emergent exploration resulting in nephrectomy. Six NOM patients had kidney-related complications (13.6%). The renal salvage rate for the entire cohort was 87.2% and 93.2% for NOM. Nonoperative management for hemodynamically stable patients with high-grade blunt renal trauma is safe with a low risk of complications. Management decisions should consider hemodynamic status and visualization of active renal bleeding as well as injury grade in determining operative management.