Concordance between renal tumour biopsy and robotic-assisted partial and radical nephrectomy histology: a 10-year experience.

We aimed to assess concordance between renal tumour biopsy (RTB) and surgical pathology from robotic-assisted partial nephrectomy (RAPN) or robotic-assisted radical nephrectomy (RARN). Patients with preoperative RTB undergoing RAPN or RARN for suspected malignancy (9 September 2013-9 September 2023) were enrolled retrospectively from three sites. Patients were excluded if the tumour had prior cryotherapy or if biopsy or nephrectomy histology were unavailable or inconclusive. The primary outcome was concordance with the presence/absence of malignancy. Secondary outcomes were concordance with tumour subtype, World Health Organisation nuclear grade (patients with RTB clear cell or papillary RCC only), false-negative rate, false-positive rate, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). In the enrolment period, 332 and 132 patients underwent RAPN and RARN, respectively. Of these, 160 received preoperative RTB, with nine patients excluded, leaving 151 eligible patients. Median age was 63 years, and 49 (32%) were female. On surgical specimens, 144 patients had malignant histology. RTB was highly concordant with presence/absence of malignancy (147/151, 97%). Concordance with tumour subtype occurred in 141 patients (93%), while concordance with nuclear grade was seen in 42/66 patients (64%, RTB grade missing in 53 patients). False-negative rate, false-positive rate, sensitivity, specificity, PPV, and NPV were 2%, 14%, 98%, 86%, 99%, and 67%, respectively. Limitations include absence of complication data and exclusion of patients biopsied without surgery. In patients undergoing RAPN or RARN, preoperative RTB has high concordance with surgical pathology, both in the presence of malignancy and RCC subtype.

A North-West London Experience of the Impact of Treatment Related Toxicity on Clinical Outcomes of Elderly Patients with Germ Cell Tumors.

Background/Aim: The occurrence of germ cell tumour (GCT) in the elderly is rare, with scarce data available. The aim of this study was to understand the clinical outcomes of patients with GCT in patients aged > 45 years. Materials and Methods: A retrospective study was conducted in a large tertiary cancer centre in north-west London. Between 1 January 2003 and 31 March 2022, 108 cases of GCT in men aged > 45 years were identified and treated at the Mount Vernon Cancer Centre. The median age at diagnosis was 54 years (range = 45−70 years). Results: The 5-year survival rate of all patients was 96%, and the toxicity profile was similar to the younger age group. Conclusion: Older patients with GCT are able to tolerate chemotherapy; however, care must be taken to prevent life-threatening complications using appropriate dose modification.

Do renal stones that fail lithotripsy require treatment?

The rates of extracorporeal shock wave lithotripsy (SWL) appear stable in the UK. However, there is little evidence on the natural history of these calculi if SWL fails. We set to look at the effectiveness of SWL in patients with a single, previously untreated renal stone and the natural history of those stones that failed treatment. We retrospectively reviewed all data from our prospectively collected database of patients undergoing a first treatment for a single renal stone between October 2010 and November 2013. Outcomes after SWL were categorised as success, subsequent intervention needed or conservative management. The medical records of patients managed conservatively were reviewed to determine whether further intervention was required and why. We further sought to define, in those patients where SWL failed, whether subsequent active intervention was needed. For the remainder, we examined whether conservative management was a reasonable management option. 313 patients fitted the inclusion criteria. Of these, 144 were treated successfully. Of the 170 patients with a residual stone, 51 went on to flexible ureteroscopy directly at their next clinical review mainly due to persistent symptoms. 79 patients were managed conservatively, and for 39 follow-up data were unavailable as their follow-up was at a different hospital. 63 patients (80%) were successfully managed conservatively with no recurrence of symptoms over the follow-up period (mean 2 years 4 months). 16 (20%) patients that were initially managed conservatively required subsequent intervention. Of these, 87% had a stone in an upper pole calyx. Conservative management of renal stones after failed SWL is a suitable option for asymptomatic patients with stones not located in the upper pole. For patients with upper pole stones, early intervention is warranted due to the high risk of requiring intervention.