Morphological Characterization of Papillary Renal Cell Carcinoma Type 1, the Efficiency of Its Surgical Treatment.

AIM: Papillary renal cell carcinoma type 1 (pRCC1) represents the second most common type of malignant renal epithelial tumour. The origin of its characteristic appearance, its growth mechanism, and the long-term efficiency of its surgical treatment remain uncertain. Our aim was to determine typical characteristics of surgically treated pRCC1. METHODS: pRCC1 was verified in 83 of 1,629 (5.1%) kidney tumours surgically treated in the period of January 2007-January 2016. The clinical and radiological characteristics, type of surgery, histopathology results and follow up data were recorded. Spearman correlation, Kruskal-Wallis analysis of variance, Fisher's exact, and chi-square test were used to analyse appropriate variables. The overall survival rate was evaluated using the Gehan-Wilcoxon test and the Cox proportional hazards model. RESULTS: The mean tumour size was 52.0 mm (15-180); 98.8% of the tumours showed a spherical shape and in 82.1%, exophytic growth was observed. Partial nephrectomy was performed in 80.7%. A majority (81.9%) were classified as pT1. Tumours, 89.2% of them, belonged to Fuhrman grade 1 or 2. The mean follow-up was 46.8 months. The overall survival was associated with pT category (p ≤ 0.0001). CONCLUSIONS: Typical signs of pRCC1 are a spherical shape, exophytic growth and low Fuhrman's grade. More than three-fourths of pRCC1 could be treated by the nephron-sparing surgery.

Three-tesla MRI biphasic angiography: a method for preoperative assessment of the vascular supply in renal tumours: a surgical perspective.

PURPOSE: The new generation of 3TMRI has improved spatial and time resolutions, which are favourable in imaging of the renal vasculature. In this study, we have compared the imaging findings of the renal blood vessels using 3TMRI and CT with intraoperative assessment of the renal vasculature as gold standard. METHODS: This prospective study was approved by the local ethical committee. Between 4/2011 and 12/2011, 80 patients with renal tumours underwent 3TMRA (angiography) (Magnetom SKYRA 3T, Siemens). Twenty of the patients were also examined with CT AG. The results of the CTA- and MRA-imaging studies were correlated with the intraoperative assessment of the renal vessels. RESULTS: Seventy patients (87.5 %) had a detailed intraoperative assessment of the renal vessels. The sensitivities for CTA and MRA were 88.2 and 88.6 %, respectively. All discrepancies between imaging studies and intraoperative findings were due to inability to identify small polar vessels. The results of MRA were concordant with CTA in 85.0 % of cases. The (three) discrepancies between MRI and CT were due to failure of MRI in identifying small polar vessels. CONCLUSIONS: (1) 3TMRA gives detailed information about the renal vasculature including its topographical anatomy. (2) With MRI, small aberrant vessels are more frequently missed than with CTA. (3) CTA remains the gold standard. However, MRA may be used for planning of laparoscopic operations. (4) The quality of the 3D reconstruction is highly depending on the skills of the radiologist.

Tubulocystic renal carcinoma: a clinical perspective.

INTRODUCTION: Tubulocystic renal carcinoma (TCRC) is a recently described neoplastic entity. To date, clinicopathological features on less than hundred cases of these rare tumours have been characterized exclusively in the pathological literature. Herein, we present five additional cases emphasizing clinical aspects on these rare renal neoplasms. MATERIAL AND METHOD: Cases diagnosed as TCRC were retrieved and reviewed from the routine and consultation files of the Pilsen tumour registry comprising over 20,000 cases of renal tumours. RESULTS: All patients were men, mean age 56 years (range 29-70). Features on computed tomography (CT) were in two cases Bosniak III, one IV and two were solid tumours. In four patients, nephrectomy was performed, and one patient underwent resection. At the time of surgery, two patients had metastases. In one case, both primary tumour and metastases were active on FDG positron emission tomography (PET)/CT. Both patients with metastatic disease were treated with sunitinib with partial response. One patient died 26 months postoperatively and the other patient is alive 5 months after surgery. Three patients with localized tumours are without evidence of disease 31, 28 and 7 months after surgery. In one case, the resected tumour was histologically combined with a papillary renal cell carcinoma (PRCC). CONCLUSION: TCRC occurs predominantly in men with a wide age range. TCRC frequently displays a cystic component which may render a radiological classification of Bosniak III or IV. FDG PET/CT is helpful in the detection of metastases. TCRC has definitive malignant potential. Our findings support a possible relationship to PRCC. The tyrosine kinase inhibitor sunitinib may be used a therapeutical agent with partial response and temporary effect.

Antegrade mini-invasive nephroureterectomy: laparoscopic nephrectomy, transurethral excision of ureterovesical junction and lower abdominal incision.

INTRODUCTION: We describe another variant of nephroureterectomy - antegrade mini-invasive nephroureterectomy (AMNUE). METHODS: AMNUE starts with a laparoscopic nephrectomy in the flank position. The specimen is enclosed in a bag without dividing the ureter, and the patient is positioned to the lithotomy position. Then the ureterovesical junction is excised transurethrally with a Collins knife. Finally, the specimen is removed and the ureter is plucked out through a short lower abdomen incision. PATIENTS: From March 2005 to November 2008, 35 patients underwent nephroureterectomy: 7 as an open procedure, 8 as a laparoscopic nephrectomy with open ureterectomy, 8 as a complete laparoscopic nephroureterectomy, and 12 were admitted into the AMNUE group (7 men and 5 women, mean age 71 +/- 7 years, range 54-81 years). RESULTS: Tumors were found 6 times on both sides. The mean operation time was 165 +/- 32 min (105-210 min), and the mean blood loss was 150 +/- 91 ml (50-400 ml). Histology revealed 11 urothelial cancers and 1 papillary renal cell carcinoma. There was only 1 hematoma of the abdominal wall. CONCLUSION: AMNUE is a fast, safe and easily reproducible technique. It eliminates the risk of spillage of tumorous cells into the urine, which is possible in techniques where the ureter is excised with a Collins knife as the first procedure. The disadvantages of this approach are the necessary repositioning of the patient and that the long-term oncological results are currently unknown. AMNUE can be used when a complete laparoscopic nephroureterectomy is not technically feasible due to problems in the pelvis.

End-stage kidney disease: gains of chromosomes 7 and 17 and loss of Y chromosome in non-neoplastic tissue.

The aim of this study was to determine the copy number changes of chromosomes 7, 17, 3p, and Y in a non-neoplastic tubular epithelium in end-stage kidney disease (ESKD). Seventeen kidneys from 11 patients with ESKD were retrieved from the archive files. Non-neoplastic kidney tissue in these cases was examined separately. Tissues containing papillary adenomas (PA), clear (CRCC) and papillary renal cell carcinomas (PRCC), and myxoid liposarcoma (LPS) were examined using the same probes and compared with non-neoplastic tissue. Tubular changes in the kidney parenchyma were classified into three types: (1) The vast majority of tubules were entirely atrophic; (2) Several tubules were hyperplastic, i.e., tubules with undifferentiated large epithelial cells, in which it was impossible to establish the specific type of a renal tubulus; (3) Dysplastic tubules were dilated, sometimes wrinkled. The basal membranes were lined by large eosinophilic epithelial cells with polymorphic nuclei and pseudostratification. Nucleoli were clearly visible. These tubular changes were multifocal with a haphazard distribution within the atrophic parenchyma. PA were detected in nine patients, of whom eight patients also revealed an additional tumor type(s) (4x CRCC, 3x PRCC, 1x PRCC, and CRCC). One patient had a CRCC only, another had a combination of PRCC and LPS. Chromosomal abnormalities were found in the second and third group of tubular changes, i.e., in hyperplastic and dysplastic tubules. Trisomy of chromosome 7 was detected in six cases, whereas trisomy of chromosome 17 in eight cases. A combination of both trisomies was found in five cases. Loss of chromosome Y was found in two cases. Fluorescence in situ hybridization on tissues containing papillary adenomas, renal cell carcinomas, and liposarcoma revealed expected results, i.e., trisomy of chromosomes 7 and 17 in all PAs and PRCC. No gains were present in CRCC and LPS. Loss of Y was found in six PA, five PRCC, and one LPS; loss of X was found in two CRCCs. We suggest that chromosomal changes typical of the papillary renal cell lesions, i.e., trisomies of chromosomes 7 and 17, are very frequent in non-neoplastic parenchyma of the end-stage kidney, and they have a tendency to a multifocal occurrence.

Renal oncocytoma with and without intravascular extension into the branches of renal vein have the same morphological, immunohistochemical and genetic features.

We attempted to investigate the clinicopathological correlation of renal oncocytoma (RO) with renal vein extension. We identified seven ROs with extension into the branches of renal vein. The age of seven patients ranged from 61 to 82 years. Five cases were identified; incidentally, two patients had gross hematuria. After surgery, all patients were alive and free of tumors with follow-up of 1 to 5 years (mean=3.6). Oncocytomas measured from 2.2 to 7.5 cm. Renal vein extension was grossly suspected in 5/7 cases and histologically confirmed in all seven cases. Tumor cells were positive for cytokeratins, mitochondrial antigen, epithelial membrane antigen, and parvalbumin; 5/7 tumors were focally positive for cluster of differentiation 117. Ultrastructurally, the cytoplasm was packed by mitochondria. Molecular genetic analysis did not detect abnormal numbers of chromosomes 1, 2, 6, 7, 10, 17, and XY by fluorescence in situ hybridization, loss of heterozygosity on 3p, and mutation of Von Hippel-Lindau gene in all cases. Array comparative genomic hybridization analysis of two cases did not show any major genetic changes. Conclusions are: (1) renal oncocytomas may have intravascular extension to the branches of the renal vein; (2) renal oncocytomas with intravascular extension to the branches of the renal vein have the same morphological, immunohistochemical, and cytogenetic findings as have their counterparts without evidence of intravascular invasion; (3) the absence of metastases suggests an overall benign behavior of this tumor, but this has to be substantiated by further studies with a long-term follow-up; (4) in a renal tumor with granular cytoplasm showing renal vein extension, it is necessary to carefully exclude renal cell carcinomas (RCC) such as chromophobe RCC, oncocytic variant of papillary RCC, and granular variant of clear cell RCC.

Renal oncocytoma with and without intravascular extension into the branches of renal vein have the same morphological, immunohistochemical, and genetic features.

We attempted to investigate the clinicopathological correlation of renal oncocytoma (RO) with renal vein extension. We identified seven ROs with extension into the branches of renal vein. The age of seven patients ranged from 61 to 82 years. Five cases were identified incidentally; two patients had gross hematuria. After surgery, all patients were alive and free of tumors with follow-up of 1 to 5 years (mean = 3.6). Oncocytomas measured from 2.2 to 7.5 cm. Renal vein extension was grossly suspected in five of seven cases and histologically confirmed in all seven cases. Tumor cells were positive for cytokeratins, mitochondrial-antigen (MIA), epithelial membrane antigen (EMA), and parvalbumin; five of seven tumors were focally positive for CD117. Ultrastructurally, the cytoplasm was packed by mitochondria. Molecular genetic analysis did not detect abnormal numbers of chromosomes 1, 2, 6, 7, 10, 17, and XY by fluorescence in situ hybridization, loss of heterozygosity on 3p and mutation of von Hippel-Lindau gene in all cases. Array comparative genomic hybridization analysis of two cases did not show any major genetic changes. Our conclusions are as follows: (1) renal oncocytomas may have intravascular extension to the branches of the renal vein; (2) renal oncocytomas with intravascular extension to the branches of the renal vein have the same morphological, immunohistochemical, and cytogenetic findings as have their counterparts without evidence of intravascular invasion; (3) the absence of metastases suggests an overall benign behavior of this tumor, but this has to be substantiated by further studies with a long-term follow-up; and (4) in a renal tumor with granular cytoplasm showing renal vein extension, it is necessary to carefully exclude renal cell carcinomas such as chromophobe RCC, oncocytic variant of papillary RCC, and granular variant of clear cell RCC.

Computed tomography of renal cell carcinoma in patients with terminal renal impairment.

PURPOSE: An increased incidence of renal tumors has been observed in patients with end-stage-renal-disease (ESRD). The very strong association with acquired renal cystic disease (ACRD) and increased incidence of the renal tumors (conventional renal cell carcinoma (CRCC), papillary renal cell carcinoma (PRCC) or papillary renal cell adenoma (PRCA)) was reported. This study discusses the role of computed tomography (CT) in detecting renal tumors in patients with renal impairment: pre-dialysis, those receiving dialysis or with renal allograft transplants. MATERIALS AND METHODS: Ten patients (nine male, one female) with renal cell tumors were enrolled into a retrospective study; two were new dialysis patients, three on long-term dialysis, and five were renal transplant recipients with history of dialysis. All patients underwent helical CT, a total of 11 procedures were performed. Sixteen-row detector system was used five times, and a 64-row detector system for the six examinations. All patients underwent nephrectomy of kidney with suspected tumor, 15 nephrectomies were performed, and 1 kidney was assessed during autopsy. CT findings were compared with macroscopic and microscopic assessments of the kidney specimen in 16 cases. RESULTS: Very advanced renal parenchyma atrophy with small cysts corresponding to ESRD was found in nine patients, chronic pyelonephritis in remained one. A spontaneously ruptured tumor was detected incidentally in one case, patient died 2 years later. In the present study, 6.25% (1/16) were multiple PRCA, 12.5% (2/16) were solitary PRCC, 12.5% tumors (2/16) were solitary conventional renal cell carcinomas (CRCC's), 12.5% tumors (2/16) were multiple conventional renal cell carcinomas (CRCC's), 25% (4/16) were CRCC's combined with multiple papillary renal cell carcinomas with adenomas (PRCC's and PRCA's), and 25% (4/16) of the tumors were multiple PRCC's combined with PRCA's without coexisting CRCC's. Bilateral renal tumors were found in our study in 60% (6/10) confirmed in six cases, one kidney left on follow-up due to the small tumors. CONCLUSIONS: With the use of a multi-detector row system, it is possible to detect smaller foci suspected to originate in multiple tumors, especially when up to 3-mm thin multi-planar reconstructions are used. Two cases demonstrated the possibility the development of RCC in impaired kidneys may start before dialysis initiation.

Tissue Biomarkers in Predicting Response to Sunitinib Treatment of Metastatic Renal Cell Carcinoma.

AIM: To identify tissue biomarkers that are predictive of the therapeutic effect of sunitinib in treatment of metastatic clear cell renal cell carcinoma (mCRCC). MATERIALS AND METHODS: Our study included 39 patients with mCRCC treated with sunitinib. Patients were stratified into two groups based on their response to sunitinib treatment: non-responders (progression), and responders (stable disease, regression). The effect of treatment was measured by comparing imaging studies before the initiation treatment with those performed at between 3rd and 7th months of treatment, depending on the patient. Histological samples of tumor tissue and healthy renal parenchyma, acquired during surgery of the primary tumor, were examined with immunohistochemistry to detect tissue targets involved in the signaling pathways of tumor growth and neoangiogenesis. We selected mammalian target of rapamycine, p53, vascular endothelial growth factor, hypoxia-inducible factor 1 and 2 and carbonic anhydrase IX. We compared the average levels of biomarker expression in both, tumor tissue, as well as in healthy renal parenchyma. Results were evaluated using the Student's t-test. RESULTS: For responders, statistically significant differences in marker expression in tumor tissue versus healthy parenchyma were found for mTOR (4%/16.7%; p=0.01031), p53 (4%/12.7%; p=0.042019), VEGF (62.7%/45%; p=0.019836) and CAIX (45%/15.33%; p=0.001624). A further significant difference was found in the frequency of high expression (more than 60%) between tumor tissue and healthy parenchyma in VEGF (65%/35%; p=0.026487) and CAIX (42%/8%; p=0.003328). CAIX was expressed at high levels in the tumor tissue in both evaluated groups. CONCLUSION: A significantly higher expression of VEGF in CRCC in comparison to healthy parenchyma can predict a better response to sunitinib.

Position of laparo-endoscopic single-site surgery nephrectomy in clinical practice and comparison (matched case-control study) with standard laparoscopic nephrectomy.

INTRODUCTION: One way how to reduce morbidity and improve cosmesic of kidney surgery is single site laparoscopy. Relatively well described concept but without defined position in clincal practise. AIM: To report of institutional experience with laparoendoscopic single-site surgery (LESS) nephrectomy (NE) and compare (matched case-control study) it with that of standard laparoscopic NE (LNE). MATERIAL AND METHODS: In the period 8/2011 to 10/2013, we performed 183 mini-invasive NE (132 tumours, 51 benign aetiology); 45 of them (24.6%) were LESS, the rest LNE. The main but not absolute indications for LESS were: non-obese men, and less advanced tumours. In 13 patients undergoing LESS-NEs (28.9%) there was a transumbilical approach. For the rest, a pararectal incision was performed and an accessory port was added in 31.1% (14) - 2/22 (9.1%) left sided, 12/23 (52.2%) right sided. Twenty-four LESS-NE were performed by a more experienced surgeon (mean operation time (MOT) 73.1 min), 21 LESS-NE by 4 other surgeons (MOT 132.8 min). These 24 were compared with 43 LNE done by the same surgeon before the period of LESS (1/2007-8/2011) and with similar characteristics of cases (body mass index (BMI) ≤ 35 kg/m(2), less advanced tumour). RESULTS: We found no statistically significant differences in any of the parameters studied. The MOT 73.1 min vs. 75.0 min (p = 0.78), BMI 27.4 kg/m(2) vs. 29.2 kg/m(2) (p = 0.08), blood loss 54.7 vs. 39.2 (p = 0.47). Complications (4.2% vs. 11.6%) were only of internal character in origin. No conversion in either group. In LESS-NE, staplers were used more frequently (more expensive than clips) for division of renal hilar vessels (70.8% vs. 51.2%). The mean price of LESS-NE was €367 higher. CONCLUSIONS: The LESS NE performed by an experienced surgeon is a safe and efficient method for the surgical treatment of both malignant and benign renal conditions in patients with BMI < 30 kg/m(2) and with low-stage tumours. The LESS NE is more expensive compared to LNE.

MiT translocation renal cell carcinomas: two subgroups of tumours with translocations involving 6p21 [t (6; 11)] and Xp11.2 [t (X;1 or X or 17)].

INTRODUCTION: MiT translocation renal cell carcinomas (TRCC) predominantly occur in younger patients with only 25% of patients being over 40 years. TRCC contains two main subgroups with translocations involving 6p21 or Xp11.2. Herein we present 10 cases. MATERIALS: Eight cases were treated at main author's institution (identified among 1653 (0.48%) cases of kidney tumours in adults). Two cases were retrieved from the Pilsen (CZ) Tumour Registry. RESULTS: Six cases were type Xp11.2 and four 6p21; 7 female, 3 male patients; Xp11.2 4:2, 6p21 3:1. The mean age 49 years (range: 21-80), 5 patients (50%) over 40 years. The mean age of the group with Xp11.2 TRCCs was 55 (median 51) and 6p21 41 (32) years. One female with a 6p21 tumour (24 years) underwent nephrectomy at 4 months of pregnancy. Stage (UICC, 7th ed. 2009) was 5xI, 3xIII, 2xIV. The mean size of tumour was 80 (40-165) mm. The mean follow-up was 33.2 (1-92) months. In patients with 6p21 tumours, one (25%) died after 3 months due to widely metastatic disease. In patients with Xp11.2 tumours, 3 (50%) succumbed due to metastatic disease (range 1-8 months). Three patients with Xp11.2 are alive at 7, 52 and 92 months of follow-up, were diagnosed at early stage (T1a). CONCLUSION: TRCCs were more common in females. Patient with 6p21 tumours were younger than those with Xp11.2. Both types have definitive malignant potential Type Xp11.2 seems to be a more aggressive neoplasm than 6p21. The case with metastatic 6p21 tumour is the 4th case described in the English literature.

Laparoendoscopic single-site surgery adrenalectomy - own experience and matched case-control study with standard laparoscopic adrenalectomy.

INTRODUCTION: At our institution, laparoendoscopic single-site surgery (LESS) has been established as a technique for laparoscopic nephrectomy since 2011, and since 2012 in selected cases for adrenalectomy (AE) as well. AIM: To compare LESS AE with standard laparoscopic AE (SLAE). MATERIAL AND METHODS: Between 3/2012 and 7/2014, 35 adrenalectomies were performed. In 18 (51.4%), a LESS approach was chosen. Indications were strictly non-complicated cases (body mass index (BMI) < 34 kg/m(2), tumour ≤ 7 cm, non-malignant aetiology, no previous surgery). All LESS procedures were done by one surgeon. Standard equipment was a 10 mm rigid 0° camera, Triport+, one pre-bent grasper, and a sealing instrument. The approach was pararectal in all cases except one (transumbilical in a slim man). Three patients with LESS were excluded (2 partial AEs only, one adrenal cancer converted to SLAE and then to open surgery). These 15 LESS AE procedures were compared to 15 SLAEs with similar characteristics chosen among 54 SLAEs performed in the period 1/2008-2/2012. RESULTS: In 8 cases (53.3%) of LESS AE, a 3 mm port was added to elevate the liver/spleen. Mean parameters of LESS AE vs. SLAE (Wilcoxon test): maximal tumour diameter 43.7 mm vs. 36.1 mm (p = 0.28), time of surgery 63.3 min vs. 55.3 min (p = 0.22), blood loss 38.0 ml vs. 38.0 ml (p = 0.38), BMI 26.9 kg/m(2) vs. 28.5 kg/m(2) (p = 0.13), discharge from hospital 5.4 days vs. 3.9 days (p = 0.038). There were no complications in either group. CONCLUSIONS: The LESS AE is feasible in selected cases, especially small left-sided tumours in thin patients with no history of previous abdominal operations, but requires an additional port in half of the cases.

Laparoscopic adrenalectomy for metachronous ipsilateral metastasis following nephrectomy for renal cell carcinoma.

INTRODUCTION: Although laparoscopic adrenalectomy (LA) is considered as a gold standard approach for adrenalectomy, there are minimal data describing options and outcomes of LA after previous ipsilateral nephrectomy (PIN). AIM: To describe our results in a group of patients who underwent LA after PIN. MATERIAL AND METHODS: From August 2004 to October 2012 we performed at our institution 88 LA. Of this amount we performed 5 LA for metachronous metastasis of renal cell carcinoma (RCC) after PIN. This group was compared to a group without previous nephrectomy. RESULTS: The group comprised 4 men (80%) and 1 woman (20%); the mean age at the time of surgery was 66.8 ±8.5 (range: 60-77) years; the mean period between nephrectomy and adrenalectomy was 5.2 (range: 1.5-14) years; the operating time was longer in patients after PIN for 7 min; the mean blood loss was higher by 22 ml; duration of hospitalization was shorter by 1.3 days, paradoxically, compared with patients without PIN. There was no need for conversion to open surgery and we did not observe any other complications. CONCLUSIONS: Laparoscopic adrenalectomy for metastasis of RCC after PIN is a technically feasible method in selected patients and it is associated with no significant differences in perioperative data in comparison with the group without prior nephrectomy. The patients benefit from minimally invasive surgery. The performance has required an experienced laparoscopic surgeon.

Managing urine leakage following laparoscopic radical prostatectomy with active suction of the prevesical space.

INTRODUCTION: Urine leakage following laparoscopic radical prostatectomy (LRP) is a possible complication that may herald chronic urine incontinence. Intraoperative measures aiming to prevent this is not standardised. AIM: Presentation of experience with active suction of the prevesical space in managing postoperative urine leakage. MATERIAL AND METHODS: At the Department of Urology, where laparoscopy of the upper abdomen and open RP were performed, a protocol for extraperitoneal LRP was established in 8/2008. Until 5/2011, 154 LRPs have been performed. Urine leakage from a suction drain appeared in 9 cases (5.8%). Permanent active suction (with a machine for Büllae thoracic drainage) of the prevesical space with negative pressure of 7-12 cm of H2O was started immediately. RESULTS: Urine leakage started after a mean of 0.9 (0-2) days postoperatively and stopped after a mean of 8.1 (15-42) days. Leakage stopped with only suctioning in 7 cases. In one case, open re-anastomosis was performed on the 7(th) postoperative day (POD). In another case, ineffective active suction was replaced on the 10(th) POD by needle vented suction without effect and the leakage stopped following gradual shortening of the drain up to the 15(th) POD. CONCLUSIONS: Active suction of the prevesical space seems to be an effective intervention to stop postoperative urine leakage after laparoscopic radical prostatectomy.

Complete laparoscopic nephroureterectomy with intravesical lockable clip.

INTRODUCTION: We present a cohort of patients with low-stage pelviureteric neoplastic disease who underwent complete laparoscopic nephroureterectomy (CLNUE) with intravesical lockable clip (IVLC). Due to the absence of a standard technique of NUE, the study was not randomized. MATERIALS: From 1/2010 to 1/2012, 21 patients were subjected to CLNUE-IVLC. The first step was transurethral excision of the ureterovesical junction with Collin's knife deep into the paravesical adipose tissue. The ureter was grasped with biopsy forceps and the distal end of the ureter was occluded with lockable clip. The applicator was introduced through a 5 mm port inserted as an epicystostomy. The patients were rotated to flank position and CLNUE followed. The endoscopically introduced clip on the distal ureter is proof of completion of the total ureterectomy. RESULTS: The mean operation time was 161 (115-200) min. In four (19.0%), the application of the clip failed and CLNUE was completed with non-occluded ureter. In three cases, subsequent laparoscopic nephrectomy was converted to open surgery. In two cases, the distal ureterectomy was completed with pluck technique through a lower abdominal incision that was also used for extraction of the specimen. There were four complications (Clavien II 2x, IIIb, V). Follow-up was available for all - mean 10.6 (range: 0-25) months. One died of disease generalization within 11 months. CONCLUSION: CLNUE-IVLC is fast and safe. If needed, the endoscopic phase can be switched to open NUE. Disadvantages include: the need to change the position of the patient, the risk of inability to apply the clip on the distal ureter, and the risk of an unclosed defect of the urinary bladder.

A distinctive translocation carcinoma of the kidney ["rosette-like forming," t(6;11), HMB45-positive renal tumor].

OBJECTIVE: Recently, a novel renal carcinoma with specific clinical and histological characteristics and translocation t(6;11)(p21.1;q12 or q13) has been identified. We have found 11 cases in the literature, and we are adding another 3 cases. MATERIALS AND METHODS: Three cases were found in the Plzen pathological register with approximately 15,000 cases of kidney tumors. There were two females and 1 male, aged 22, 24, and 39 years. RESULTS: The sizes of the tumors were 40, 136, and 10 mm. Two tumors were found incidentally; the biggest one was self-palpated by a 24-year-old pregnant patient. Patients are without any signs of disease 42, 20, and 17 months after surgery. CONCLUSION: This tumor is a distinctive and rare translocation carcinoma of the kidney [t(6;11), HMB45 positive]. All cases with known clinical data arose in younger people. The malignant potential is probably low.

GreenLight (532 nm) laser partial nephrectomy followed by suturing of collecting system without renal hilar clamping in porcine model.

OBJECTIVES: To assess the feasibility of partial nephrectomy (PN) without renal hilar clamping using the 80-W GreenLight (532 nm) laser with opening of the collecting system followed by its suture in a porcine model. METHODS: We performed 12 open laser PNs in 6 farm pigs. We used the technique of incisional laser ablation of the lower pole of the right kidney. The pigs were kept alive, and 2 weeks later, underwent the same technique on the left kidney, followed by immediate killing. We recorded the acute and chronic outcomes. Renal parenchyma resection was achieved solely with the laser. The collecting system was opened with the laser in each procedure. All renal specimens underwent retrograde pyelography and histologic examination. RESULTS: All procedures were completed without renal hilar clamping. The mean operative and laser time was 67.1 +/- 20.6 minutes (range 35-95) and 17.8 +/- 6.4 minutes (range 10-30), respectively. The mean resected kidney mass was 17% +/- 0.5% (range 10%-27%) of the total kidney mass. The mean blood loss was 142.5 +/- 88.9 mL (range 50-350). No evidence of urinary extravasation was seen after the acute procedures, but proven urinomas with decayed suture were found after all chronic procedures. CONCLUSIONS: PN using the GreenLight laser is a feasible method for renal parenchyma incisional ablation. The laser hemostatic effect of interlobar vessel bleeding is safe and sufficient. The sutured collecting system after laser PN cannot heal in the thermically damaged tissue. The method is applicable to peripherally located lesions, without entering the collecting system. More prospective animal studies are necessary before application in humans.