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The wide availability of cross-sectional imaging is responsible for the increased detection of small, usually asymptomatic renal masses. More than 50 % of renal cell carcinomas (RCCs) represent incidental findings on noninvasive imaging. Multimodality imaging, including conventional US, contrast-enhanced US (CEUS), CT and multiparametric MRI (mpMRI) is pivotal in diagnosing and characterizing a renal mass, but also provides information regarding its prognosis, therapeutic management, and follow-up. In this review, imaging data for renal masses that urologists need for accurate treatment planning will be discussed. The role of US, CEUS, CT and mpMRI in the detection and characterization of renal masses, RCC staging and follow-up of surgically treated or untreated localized RCC will be presented. The role of percutaneous image-guided ablation in the management of RCC will be also reviewed.

Background: At present, it is not possible to predict the ablation zone volume following irreversible electroporation (IRE) for prostate cancer (PCa). This study aimed to determine the necessary electrical field threshold to ablate human prostate tissue in vivo with IRE. Methods: In this prospective multicenter trial, patients with localized PCa were treated with IRE 4 weeks before their scheduled radical prostatectomy. In 13 patients, numerical models of the electrical field were generated and compared with the ablation zone volume on whole-mount pathology and T2-weighted magnetic resonance imaging (MRI) sequences. Volume-generating software was used to calculate the ablation zone volumes on histology and MRI. The electric field threshold to ablate prostate tissue was determined for each patient. Results: A total of 13 patients were included for histological and simulation analysis. The median electrical field threshold was 550 V/cm (interquartile range 383-750 V/cm) for the software-generated histology volumes. The median electrical field threshold was 500 V/cm (interquartile range 386-580 V/cm) when the ablation zone volumes were used from the follow-up MRI. Conclusions: The electrical field threshold to ablate human prostate tissue in vivo was determined using whole-mount pathology and MRI. These thresholds may be used to develop treatment planning or monitoring software for IRE prostate ablation; however, further optimization of simulation methods are required to decrease the variance that was observed between patients.

To evaluate cancer involvement of internal female genitalia of patients undergoing anterior exenteration for clinically organ confined transitional cell carcinoma of the bladder, and identify potential preoperative risk factors. Charts and anterior exenteration specimens from 54 women with clinically organ confined transitional cell bladder cancer were retrospectively reviewed. Emphasis was given to the presence of internal genitalia involvement and or primary gynecologic pathology. Unsuspected internal genitalia involvement was reported in only three patients (5.7%). The vagina was involved in two cases (3.8%) while the uterus in one (1.9%). In all cases involvement was due to direst extension from bladder tumors of the base and dome respectively. No preoperative variable could predict internal genitalia involvement in a statistical significant manner. Benign pathology of the female reproductive organs was observed in six patients and involved in all cases the uterus (11.5%). Internal genitalia involvement after radical cystectomy for TCC tumors of the bladder is rare (5.8%). Preoperative risk factors could not be identified although all involved genitalia were seen in tumors of the bladder dome and base. Therefore large multi-institutional studies are needed in order to identify preoperative risk factors for internal genitalia involvement in females with bladder cancer.

OBJECTIVE To retrospectively evaluate the findings during re-exploration for obstructive ileus after radical cystectomy (RC) and ileal conduit diversion. PATIENTS AND METHODS During a 12-year period, 434 patients who had RC and ileal conduit diversion were retrospectively evaluated for the diagnosis of early (

Purpose: In the outpatient office setting we evaluated the feasibility and efficacy of ureteroscopic removal of upward migrated ureteral stents using local or no anesthesia. Materials and Methods: Prospectively 37 patients with mild upward stent migration underwent ureteroscopic stent removal under local or no anesthesia. Stent migration was always below the pelvic brim. It was diagnosed by plain x-ray of the kidneys, ureters and bladder, and flexible cystoscopy. Semirigid ureteroscopy was performed in the office outpatient setting. After each procedure patients graded the discomfort and/or pain level experienced by completing 2 separate 5-scale visual analog pain scores, including I for flexible cystoscopy and 1 for the ureteroscopic procedure. Pain scores were compared between the 2 procedures. Results: Stent removal was successful in 34 of 37 patients (91.9%). Successful procedures were never interrupted due to pain intolerance. No complications occurred. The mean visual analog pain score for ureteroscopic stent removal was 1.73 and it was similar in men and women (p=0.199). The mean visual analog pain score for flexible cystoscopy was 1.27. This procedure was significantly more painful in men than in women (p=0.018). Ureteroscopic stent removal was more painful than flexible cystoscopy overall and in women (each p

Objectives. Robotic camera holders provide steady camera movement and view during laparoscopic surgery. We compared two such robots, EndoAssist and AESOP, by evaluating timed setup and surgical performance during laparoscopic radical prostatectomy (LRP). Methods. We prospectively collected data for 20 patients undergoing LRP using either the EndoAssist or AESOP. AESOP was mounted to the surgical bed and controlled by an experienced assistant using a hand-held remote control. The EndoAssist device was placed over the patient’s right shoulder. Its movements were executed by the surgeon using a head-mounted optical emitter with brief head movements detected by a sensor mounted atop the surgeon’s video monitor. The robot setup time and LRP operative steps were timed and compared between the two cohorts. Results. The time for robot setup favored AESOP over the EncloAssist (2.0 minutes versus 5.3 minutes, P = 0.001). The time for accomplishing vas deferens and seminal vesicle dissection favored the EncloAssist (23 minutes versus 33 minutes, P = 0.04). However, no statistically significant difference was found in the efficiency of task performance between the two robots in any of the other I I steps measured. Conclusions. The EncloAssist appears to be equally efficient to the assistant-controlled AESOP robot with respect to surgical performance during LRP. The advantages of the EncloAssist include its accurate response and ability to provide the surgeon with complete control of the desired operative view without relying on an assistant. Its disadvantages include its large profile, lack of a table-mounted design, and the need for pedal activation. Additional modifications are needed to improve the efficiency and design of this novel robotic device further.