Effect of Positive Surgical Margins in Patients Who Undergo a Partial Nephrectomy Regarding Recurrence, Overall Survival, Recurrence/Progression-Free Survival, and Metastasis-Free Survival. A Systematic Review and Meta-Analysis.

BACKGROUND: To determine the effect of positive surgical margins in patients who undergo a partial nephrectomy regarding recurrence, overall survival, disease-free survival, recurrence and progression-free survival, and metastasis-free survival. METHODS: We performed a systematic review accomplishing with Cochrane recommendations. We searched in Medline, Embase, and central. We also looked for unpublished literature. There was no language or setting restrictions. We performed a random-effects meta-analysis for all outcomes. RESULTS: We included 44 studies for qualitative and quantitative analysis. We found that positive margins increase the risk of local recurrence (RR 4.14 95%CI 2.75-6.24), recurrence (RR 4.8 95%CI 3.38-6.62), mortality (RR 1.83 95%CI 1.08-3.1), metastasis (RR 8.1 95%CI 3.88-16.92), and improved the recurrence/progression-free survival (HR 2.9 95%CI 1.88-4.49) and metastasis-free survival (HR 2.91 95%CI 1.25-6.79) with moderate, moderate, very low, very low, and high certainty of the evidence, respectively. We found no change in overall survival (HR 1.48 95%CI 0.98-2.22) with very low certainty of evidence. CONCLUSIONS: A positive margin is an independent predictor of local recurrence, recurrence, mortality, metastasis, with no effect on overall survival. Therefore, a tailored intense and prolonged follow-up is mandatory.

Technique Description and Outcomes of Robotic Transvaginal-Assisted Living Donor Kidney Transplantation.

OBJECTIVE: The aim of the study was to describe the surgical technique of totally robotic kidney transplantation with transvaginal insertion and to assess its safety and feasibility. METHODS: It is a prospective analysis of the first 5 cases of robotic kidney transplantation with transvaginal insertion. Robotic-assisted kidney transplantation was performed after transvaginal insertion of a living donor kidney graft. Donor's and recipient's characteristics, intraoperative variables, postoperative complications, and surgical outcomes were assessed. RESULTS: The median operative time was 220 min. Mean rewarming ischemia time of 53 min, with immediate diuresis. No intraoperative complications were observed. Mean hospitalization period was 9 days, with mean Cr of 1.5 mg/dL at discharge. CONCLUSIONS: Robotic kidney transplantation with transvaginal insertion is feasible and safe. A greater number of procedures are required to confirm the results of this new technique.

Development and feasibility assessment of a 3 day electronic bladder diary as an app for smart-phone.

AIMS: To develop a 3 day bladder diary (BD) as an easy-to-use application for smart-phone (eDM3d). To test its feasibility and acceptance in a reduced number of patients. METHODS: An external agency developed the eDM3d following the structure of the Spanish validated 3 day BD (DM3d©), which includes a frequency-volume chart, the assessment of the grade of urgency, the incontinence events and fluid intake. The eDM3d consisted in a main interface of four buttons ("wake up," "go to bed," "urinate," "drink") which had to be clicked to create an event. Results were automatically transferred to an internet server to obtain an electronic report. We recruited 25 patients with overactive bladder syndrome or nocturia and previous experience on paper BD. They were asked to complete the eDM3d. Finally, a direct question about satisfaction was answered: "If you had to complete a BD again, would you choose the paper or the app version?" RESULTS: Three patients (12%) did not complete the eDM3d, 1 patient (4%) completed 2 days of the eDM3d and did not register volumes of micturition nor fluid intake, 1 patient (4%) completed all 2 days variables and 20 patients (80%) completed all 3 day variables. Regarding satisfaction, 19 patients (86.4%) would choose the app version, 2 patients (9.1%) would choose a paper version and 1 patient (4.5%) would choose either indistinctly. CONCLUSIONS: The eDM3d is a useful tool easily filled in by patients with a high satisfaction rate. Adequate validation of the eDM3d is required.

Metastasis of gastric carcinoma simulating a urothelial tumor. Case report and review of the literature.

OBJECTIVE: To review two cases with the diagnostic suspicion of urinary tract tumor by clinical picture and imaging tests in which pathology of the surgical specimen revealed metastasis of gastric adenocarcinoma. METHODS: 82 and 68 year-old patients with past history of gastric adenocarcinoma that had undergone surgical treatment 6 months and 6 years before urology consultation,respectively. They were diagnosed upper urinary tract tumors by CT scan. RESULTS: Definitive pathologic diagnosis of urinary tract metastasis of gastric adenocarcinoma was obtained after radical surgery in both cases. CONCLUSIONS: Clinical and radiologic presentation of urothelial metastases of gastric adenocarcinoma may simulate de novo urothelial tumors. Evolution in these patients is usually bad although we currently don't have enough information to issue a therapeutic guide to follow.

Validation of Randall's plaque theory using unenhanced abdominal computed tomography.

OBJECTIVE: To determine whether nephrolithiasis is associated with radiographic changes in renal papillae. MATERIALS AND METHODS: We performed a prospective study comparing papillae attenuation in a stone-forming group (SFG) and a healthy stone-free control group (CG). The SFG inclusion criteria were active stone disease diagnosed by abdominal computed tomography and stone analysis showing calcium composition. For the CG, we included living kidney donors without stone disease. Papillae tip attenuation was measured using nonenhanced computed tomography scans in Hounsfield units (HUs) for an area with a mean size of 0.1 cm(2). The mean density of the 3 caliceal groups was calculated for each kidney. Student's t test was used for statistical analysis, and the receiver operating characteristic curve was used to determine a threshold separating the CG and SFG. RESULTS: A total of 134 SFG and 134 CG patients met the inclusion criteria. The SFG and CG had similar demographic characteristics. Unilateral lithiasis was encountered in 92 patients (68.6%). The mean HU density of the papillae of the affected side in the SFG was significantly greater than in the CG (43.9 HU vs 33.9 HU, P = .001). No significant difference was seen between the affected and unaffected side in the SFG (43.9 HU vs 42.9 HU, P = .56). The receiver operating characteristic analysis showed an area under the curve of 0.91, with an optimal threshold at 40 HU and a specificity of 92% and a sensitivity of 91%. CONCLUSION: The density of the renal papilla significantly increased in the SFG in both the affected and the nonaffected kidneys compared with the CG. These findings suggest the presence of calcium deposits in the papillae, validating Randall's theory.

Unenhanced CT findings can predict the development of urinary calculi in stone-free patients.

OBJECTIVES: To determine if calcium deposits in the papillae can be identified by unenhanced computed tomography (uCT) even before renal stones develop. METHODS: A retrospective review of 413 patients with calculi identified 31 patients (stone-forming group) with a history of urinary tract calculi with a calculus demonstrated by uCT and a stone-free uCT before calculi had developed. The control group (n = 31) was composed of live kidney donors with no history of calculi and a stone-free uCT. CT attenuation was measured in all CTs using two regions of interest of 0.05 cm(2) and 0.1 cm(2) over the tip and the neighbouring area of the papillae. Student's and Wilcoxon t-tests were used for comparing results in the two groups. RESULTS: The attenuation of the tip of the papilla was higher in the stone-forming group when compared to the controls after (45.2 HU versus 32.1 HU, P = 0.001) and even before frank calculi had developed (44.2 HU versus 32.1 HU, P = 0.003). There was no significant difference in papillary attenuation in the stone group before and after calculi had developed (45.2 HU versus 44.2 HU, P = 0.82). CONCLUSION: Stone-forming patients exhibit higher papillary density even before calculi develop. This could define a population at risk of developing calculi.

[Surgical aspects of living-donor kidney transplantation]. / Aspectos quirúrgicos de la donación de vivo.

Laparoscopic living donor nephrectomy has shown less morbidity than the open approach, with less pain and analgesia requirements and allowing a quicker recovery and an earlier return to normal activity. Furthermore, many studies have shown equivalent results between both approaches in terms of graft functions and recipient complications. For these reasons, we can accept laparoscopic kidney living donor nephrectomy as the gold standard surgical technique in these patients. The implementation of this minimally invasive technique in most centers has led to an increase in the rate of this kind of organ procurement, due to its better acceptance by the donors. In order to decide which kidney is better to extract, it is mandatory to maintain the best kidney in the donor. In case equal conditions, it is advisable to perform left nephrectomy.

[First report on hybrid transvaginal nephrectomy for renal cancer]. / Primera nefrectomia transvaginal híbrida por cáncer renal.

NOTES (Natural Orifice Transluminal Endoscopic Surgery) is a surgical modality that uses empty organs as an access to the peritoneal cavity, avoiding skin incisions. If we combine this surgery with the classical laparoscopic approach, a new hybrid technique is obtained. This approach will permit us to work on wide operating fields with large organs, as the kidney, minimizing skin incisions. We present the first hybrid transvaginal radical nephrectomy due to renal cancer. In order to perform this procedure, we used a vaginal access for introduction of a deflectable camera and the assistance of two additional abdominal trocars. The vaginal incision for the trocar was enlarged for organ removal. Hybrid transvaginally NOTES assisted radical nephrectomy is a reproducible and feasible technique that has to be kept in mind for women who are candidates to nephrectomy for renal cancer.

Ureteroscopia: primeros 56 casos del Hospital Clínico y Provincial de Barcelona, España / Ureteroscopy: first 56 cases from the Hospital Clínico y Provincial, Barcelona, Spain

Se presenta la experiencia del Servicio de Urología del Hospital Clínico y Provincial de Barcelona con los primeros 56 casos de ureteroscopisa, procedimiento que se efectuó con instrumento rígido, así como con la aplicación de los diferentes equipos apropiados para aumentar la eficacia de la técnica. Alternativas que posee el urólogo para el diagnóstico y el tratamiento endoscópicos adecuados de diferentes alteraciones patológicas ureterales son buena selección de los pacientes, combinación de diversas maniobras y elección de material adecuado.