Wound related complications and the anterior rectus sheath versus Gibson approach to kidney transplantation: A single center randomized controlled trial.

INTRODUCTION: Wound related complications (WRC) are a significant source of morbidity in kidney transplant recipients, and may be mitigated by surgical approach. We hypothesize that the anterior rectus sheath approach (ARS) may decrease WRC and inpatient opiate use compared to the Gibson Approach (GA). METHODS: This double-blinded randomized controlled trial allocated kidney transplant recipients aged 18 or older, exclusive of other procedures, 1:1 to ARS or GA at a single hospital. The ARS involves a muscle-splitting paramedian approach to the iliopsoas fossa, compared to the muscle-cutting GA. Patients and data analysts were blinded to randomization. RESULTS: Seventy five patients were randomized to each group between August 27, 2019 and September 18, 2020 with a minimum 12 month follow-up. There was no difference in WRC between groups (p = .23). Nine (12%) and three patients (4%) experienced any WRC in the ARS and GA groups, respectively. Three and one Clavien IIIb complications occurred in the ARS and GA groups, respectively. In a multiple linear regression model, ARS was associated with decreased inpatient opioid use (ß = -58, 95% CI: -105 to -12, p = .016). CONCLUSIONS: The ARS did not provide a WRC benefit in kidney transplant recipients, but may be associated with decreased inpatient opioid use.

Serial Anatomical Prostate Ultrasound during Prostate Cancer Active Surveillance.

PURPOSE: The growth potential of low grade prostate cancer is unknown and yet it is potentially impactful for the practice of active surveillance. We evaluated the incidence, growth dynamics and clinical significance of changes in prostate lesions on serial transrectal ultrasound among a large cohort of men with prostate cancer managed by active surveillance. MATERIALS AND METHODS: This retrospective study included men with prostate cancer treated with active surveillance at UCSF (University of California-San Francisco) from 2000 to 2014 who underwent a minimum of 2 transrectal ultrasound studies. Study inclusion criteria were prostate specific antigen 20 ng/ml or less, clinical stage T2 or less and biopsy Gleason grade 3 + 4 or less. Progression end points included an increase in imaging stage, a 50% or greater increase in volume and an increase in the number of sites (sextants) with apparent lesions. The relationship between transrectal ultrasound progression and biopsy Gleason upgrade was assessed by univariate and multivariate logistic regression models. RESULTS: The 875 identified patients underwent a median of 5 transrectal ultrasound studies (IQR 3-8). Median followup was 49 months (IQR 27-81). Of the patients 345 (39%) progressed on serial transrectal ultrasound, including 51 by size, 265 by the number of lesion sites and 279 by stage. Median time to progression was 14 months. Transrectal ultrasound progression was independently associated with biopsy upgrade (OR 1.8, 95% CI 1.3-2.5, p <0.01). CONCLUSIONS: Local progression on transrectal ultrasound was associated with Gleason upgrade at biopsy. These results suggest that stable imaging findings on transrectal ultrasound may allow for increased intervals between biopsies among men on active surveillance. A prospective study is required to evaluate the usefulness of such a practice.