Active Surveillance in Metastatic Renal Cell Carcinoma.

Metastatic renal cell carcinoma (mRCC) is a heterogenous disease with a variable clinical course. While therapies for treatment of this condition have progressed, they are not without toxicity. In some patients, active surveillance (AS) of this disease is increasingly considered to delay its toxicity. This article seeks to review the literature and discuss management of metastatic renal cell carcinoma, specifically regarding upfront AS, the role of radiation therapy in delaying systemic therapy, and surveillance after initial treatment with systemic therapy. Median time on AS prior to initiation of systemic therapy ranged from 14 to 60 months across studies. AS is appropriate to offer in favorable or intermediate risk, asymptomatic, and systemic treatment naïve patients with mRCC.

Fournier's Gangrene in Females: Presentation and Management at a Tertiary Center.

OBJECTIVE: To report and compare presentation and management of Fournier's Gangrene (FG) in female vs male patients at a single tertiary care center. METHODS: Patient demographics, clinical characteristics, treatments and outcomes were summarized and compared between males and females who were treated for FG from 2011 to 2018 at a single institution. RESULTS: Of the 143 patients treated for FG at our institution, 33 (23%) were female. Female patients were predominantly white (82%), with a median (IQR) age of 55 (46, 59). Median female boby mass index (BMI) was 42.1 (32, 50.4). Female patients' wound cultures were polymicrobial mix of gram positive and gram negative organisms. Median number of debridements for females was 2 (1,3). The most common anatomic region of gangrene involvement in females was labia (76%) followed by perineum (55%) and gluteus/buttocks (42%). Mortality rate during initial admission was 6% for females. Female patients had a higher median BMI than males (42.1 vs 33.7 respectively; P = .003). FG severity index, length of hospital stay, number of debridements, and wound cultures were comparable to males. The surgical team managing initial debridements differed with females managed primarily by general surgery and males primarily by urology. Mortality rate was comparable to men (6% vs 7%, P >.05). CONCLUSION: Female patients with FG have greater BMI but similar clinical presentation, microbiologic characteristics and mortality rate compared to men. Urologists have little involvement during initial management for females at our institution.

Is Delayed Phase Computed Tomography Imaging Necessary After Blunt Renal Trauma in Children?

OBJECTIVE: To characterize the utilization of delayed phase computed tomography (CT) imaging in blunt renal trauma and determine if the omission of delayed phase CT imaging affected clinical outcomes in children. MATERIALS AND METHODS: A prospectively collected trauma database was reviewed between 2006 and 2016 to identify patients aged ≤21 years with a diagnosis of renal injury from blunt trauma. Demographic characteristics, injury grade, Injury Severity Score, non-kidney organ injuries, radiologic studies, and clinical course were reviewed. Patients were categorized into 2 groups: those who received CT with delayed images in the emergency room and those who did not. RESULTS: In total, 121 patients met the inclusion criteria. Delayed scans were obtained in 50 patients (41%) but omitted in 71 (59%). Age, weight, non-kidney organ injuries, and imaging location did not differ between groups. Injury Severity Score was higher in the no-delay group than in the delay group (median 16 vs 10, respectively, P = .40). Median length of stay was 3 days without significant differences by cohort (P = .24). The proportion of patients who received abdominal CT scans after admission, underwent a urologic procedure, or were readmitted did not differ significantly between groups. CONCLUSION: This study was unable to demonstrate a difference in outcomes between patients who had a CT with delayed imaging and patients who did not. This questions the universal necessity for delayed images after blunt renal trauma. Future prospective studies are necessary to develop pediatric trauma guidelines that balance imaging needs and radiation exposure.