Growth rates are similar in potentially benign and malignant small renal masses detected incidentally.

OBJECTIVE: Generally small renal masses grow at slow rate; some of them do not exhibit any growth. Does it mean that they are less aggressive? The aim of our study was to compare the growth of enhancing, non-enhancing solid renal masses, angiomyolipomas and complex renal cystic masses < or =4 cm in diameter. MATERIALS AND METHODS: 12 patients with solid enhancing, 20 with solid non-enhancing, 8 with angiomyolipomas and 25 with Bosniak II/IIF/III and IV masses were enrolled and prospectively studied during the surveillance period. The mean diameter of the lesion at presentation was 3.5; 3.1; 3.2 and 3.9 cm, the mean period of observation was 47; 48; 35 and 48 for each group respectively. All masses were detected incidentally. Progression rates (the largest diameter was calculated) were compared among the groups. RESULTS: The range and mean growth rates among all groups after one year of observation were (0.0-0.3; 0.2 cm); (0.0-0.3; 0.2 cm); (0.0-0.4; 0.3 cm); (0.0-0.3; 0.1 cm); (0.0-0.2; 0.1 cm); (0.0-0.0; 0.0 cm) and (-0.6-0.0; -0.2 cm) for 7 groups respectively. Overall 55.4% of masses did not exhibit any growth. We did not monitor any pathological lymph node enlargement, distant metastases in any group of patients. Overall, 85% of masses that exhibited growth during the first year did so at the end of follow up. CONCLUSIONS: The vast majority of small solid and complex cystic renal masses exhibit similar slow growth rates. According to these results, urologists can not predict the biological potential of the mass based on radiographic criteria and growth rates only (Tab. 2, Ref. 12).

Critical appraisal of prognostic factors for transobturator tape implantation.

OBJECTIVES: The aim of the study was (1) to compare early results of transobturator tape (TOT) implantation in women with lower and higher Valsalva leak point pressure (VLPP) and (2) to find out significant and independent prognostic factors of TOT implantation. MATERIAL AND METHODS: 97 female patients (pts) underwent TOT implantation between March 2004 and September 2007. We observed preoperative parameters including VLPP, urine leakage (PWT1), quality of life (IQOL1), age, BMI, parity, previous anti-incontinence surgery, hysterectomy status (HYE) and symptoms of OAB. According to VLPP value, pts were divided into two groups, namely those with lower VLPP values (< or =60 cmH2O) and those with higher VLPP values (> 60 cmH2O). Two different tapes were used for TOT implantation (resorbable and non-resorbable). Six months after surgery, urine leakage (PWT2) was reassessed and pts were classed into two main categories as 'cured' (PWT2 < or =2 g), or 'not cured' (PWT2 >2 g). RESULTS: Pts with lower VLPP values had significantly lower cure rates than those with higher VLPP values (43.8% vs. 81.5%, p < 0.001, respectively). Univariate logistic regresion analysis identified VLPP, PWT1, IQOL1, age, HYE, and TOT type parameters as significant factors for cure. Of these significant parameters, the multivariate logistic regresion analysis identified PWT1 and TOT type as the only independent ones. CONCLUSIONS: Pts with lower VLPP values are at a five-fold greater risk of not being cured than those with higher VLPP values. Preoperative urine leakage and TOT type are the only independent prognostic factors for cure after TOT implantation (Tab. 5, Fig. 3, Ref. 32).

Spontaneous regression of complex cystic renal mass of bosniak class IV--a rare phenomenon.

Spontaneous remission of simple renal cyst or complex renal cyst Bosniak III or IV class is a rare phenomenon. Our report describes a spontaneous partial regression of complex renal cyst Bosniak IV during the observation of complex cystic renal masses. A 66 year old male high risk patient (ASA score 3-4) refused all surgical intervention and was suggested for active surveillance strategy. We observed spontaneous partial regression of the complex cyst in this patient. To our knowledge this is the first report of spontaneous partial regression of complex renal cyst Bosniak IV class (Fig. 3, Ref. 5). Full Text (Free, PDF) www.bmj.sk.

Valsalva leak point pressure predicts outcome after transobturator suburethral tape implantation--fact or fiction?

INTRODUCTION AND OBJECTIVES: The aim of the study was to assess the influence of Valsalva leak point pressure (VLPP) on outcome of transobturator suburethral tape (TOT) implantation. MATERIAL AND METHODS: 65 female patients underwent surgery between March 2004 and November 2005. Their inclusion criterion was urodynamic stress urinary incontinence (SUI). The exclusion criteria were detrusor overactivity, detrusor underactivity, a significant post-void residuum and genital prolapse. "Subjective improvement" was considered as the difference between postoperative urinary-incontinence specific quality of life compered with its preoperative value (deltaIQoL=IQoL*-IQoL). RESULTS: Postoperative leakage and postoperative urinary incontinence specific quality of life in 1st versus 2nd group were 1.2+/-1.1 g and 90.6+/-5.1 versus 4.6+/-3.1 g and 84.0=5.6 respectively (p<0.005 and p<0.005 respectively). CONCLUSIONS: Cure and success rates were significantly higher in patients with higher VLPP values compared with patients with lower VLPP values. In spite of the fact that patients with higher VLPP values achieved significantly lower postoperative leakage, urine leakage decreased significantly more in patients with lower VLPP values. Patients with higher VLPP values reached significantly higher postoperative urinary incontinence-specific quality of life, however no significant difference was found in subjective improvement between patients with higher and lower VLPP values (Tab. 1, Ref. 23).

Persistent tuberculous cystitis: the most common indication for nephrectomy in the management of urogenital tuberculosis.

There were 631 patients treated for proven urogenital tuberculosis in 1966-1985. Indications for nephrectomy were retrospectively analyzed in 137 (21.7%) patients operated. A badly damaged or functionless kidney was removed in 85 (62.0%) patients for the early control of persistent tuberculous cystitis; in 18 (13.1%) because of chronic, nonspecific urinary infection, dispersed calcifications with subsequent nephrolithiasis, pain or other discomfort; in 16 (11.7%) due to supposed nephrogenic hypertension, and in 3 (2.2%) because of extrarenal disease. In 15 (10.9%) patients the symptomless kidney was removed preventively. The management of renal tuberculosis by itself did not need nephrectomy.