Percutaneous cryoablation of renal masses: Washington University experience of treating 129 tumours.

UNLABELLED: WHAT'S KNOWN ON THE SUBJECT? AND WHAT DOES THE STUDY ADD?: For patients who are unfit for extirpative surgery, percutaneous cryoablation (PCA) presents a minimally-invasive alternative for the treatment of renal masses. PCA has been demonstrated to be safe, with complication rates <10% being reported consistently. Studies have suggested that a minimal and insignificant decline in renal function can occur after PCA. Finally, among studies with a follow-up >20 months, treatment success rates range from 75% to 96%. However, longer-term oncological and functional results for patients treated with PCA are relatively limited. The present study profiles one of the largest reported experiences with PCA for renal masses: 129 tumours in 124 patients. Our complication rate was comparable to that observed in other reported studies. At a mean follow-up of 30 months, treatment success was achieved in 87% of tumours, which is in line with published PCA success rates. On multivariable analysis, tumour size >3.0 cm was found to be significantly associated with treatment failure. A minimal but statistically significant renal functional decline was observed, with 20% of patients experiencing a progression in National Kidney Foundation-Chronic Kidney Disease stage. On multivariable analysis, age >70 years, hilar tumour location and postoperative day 1 estimated glomerular filtration rate <60 mL/min/1.73 m(2) were found to be significantly associated with renal functional decline. The present study confirms that PCA of renal masses represents a safe alternative to surgery in patients with substantial medical comorbidities. In the present cohort, baseline patient and tumour characteristics probably impact the risk of tumour recurrence, as well as renal disease progression, after PCA. OBJECTIVE: To evaluate perioperative, oncological and functional outcomes after percutaneous cryoablation (PCA) for renal masses based on our single-centre experience. PATIENTS AND METHODS: We retrospectively identified 124 patients who underwent PCA for 129 renal tumours between March 2005 and June 2011. Patient demographics and baseline clinical characteristics, tumour features, perioperative information, and postoperative outcomes were recorded. Oncological outcomes were defined by radiographic evidence of recurrence on follow-up computed tomography or magnetic resonance imaging. Renal disease progression was defined by a change in National Kidney Foundation-Chronic Kidney Disease stage. RESULTS: Patients had mean (sd) age of 72.6 (10.2) years; mean (sd) tumour size and nephrometry score were 2.7 (1.1) cm and 6.5 (1.7), respectively. Our overall complication rate was 9% (11/124), whereas the major (greater than Clavien II) complication rate was 2% (2/124). Significant predictors of renal disease progression following PCA included age ≥ 70 years (odds ratio [OR], 4.31, P = 0.03), hilar tumour location (OR, 4.67, P = 0.04), and post operative day 1 estimated glomerular filteration rate ≤60 mL/min/1.73 m(2) (OR, 7.09, P = 0.02). Our treatment success rate was 87% (112/129) at a mean (sd) follow-up of 30.2 (18.8) months. Tumour size ≥3.0 cm was significantly associated with PCA failure (hazard ratio, 3.21, P = 0.03). CONCLUSION: PCA provides a safe and oncologically effective alternative to extirpative surgery for renal masses in patients with significant medical comorbidities.

Partial nephrectomy in two patients with known T3a tumours involving the renal vein.

UNLABELLED: Study Type--Therapy (case series). Level of Evidence 4. What's known on the subject? And what does the study add? Although nephron-sparing surgery (NSS) has became accepted therapy for T1 tumours, radical nephrectony is considered the best therapy for T3a tumours involving the renal vein. NSS can be considered in T3a or greater tumours if imperative indications exist, such as bilateral disease or solitary kidney. However, there is little published data on the characteristics of these patients, the impact of surgery on their renal function, and long-term oncologic outcomes. This study profiles single-institution experience with nephron-sparing surgery for known T3a tumours involving the renal vein, including patient characteristics, tumour characteristics, preoperative and follow-up imaging, preoperative and follow-up estimated glomerular filtration rate, length of temporary postoperative haemodialysis, and oncologic outcome. Additionally, we compare this to other published data on nephron-sparing surgery for similar tumors. OBJECTIVE: • To present two patients with T3a tumours involving the renal vein who underwent nephron-sparing surgery (NSS) for imperative reasons. PATIENTS AND METHODS: • Retrospective chart review of patients who underwent NSS for renal cell carcinoma (RCC) with known renal vein tumour thrombus (RVTT). • Both patients underwent open partial nephrectomy and renal vein thrombectomy of a solitary kidney. • Primary outcomes of the study include radiographic evidence of recurrence, haemodialysis requirement and estimated glomerular filtration rate (eGFR) before and after surgery. RESULTS: • Patient 1 is 24 months from NSS and has no evidence of recurrence based on CT scan. His final pathology revealed a 9-cm, T3a, clear cell, Fuhrman grade II carcinoma. He spent 42 days on haemodialysis and is now off all dialysis. His preoperative and most recent eGFR are 48 and 23 mL/min/1.73 m(2) based on the Modification of Diet in Renal Disease (MDRD) equation and 69.4 and 29.8 mL/min by the Cockcroft-Gault equation. • Patient 2 is 9 months from NSS and has no evidence of recurrence based on CT scan. Her final pathology revealed a 6-cm, T3a, clear cell, Fuhrman grade II-III carcinoma. She spent 30 days on haemodialysis and is now off all dialysis. Her preoperative and most recent eGFR are 58 and 30 mL/min/1.73 m(2) based on the MDRD equation and 62.2 and 32.8 mL/min by the Cockcroft-Gault equation. CONCLUSION: • Based on our review, preservation of renal function and favourable oncological outcome can be accomplished with NSS in patients with known stage T3a RCC with RVTT and should be considered in carefully selected patients.

Robot-assisted pyeloplasty: outcomes for primary and secondary repairs, a single institution experience.

INTRODUCTION: Robotic Pyeloplasty (RAP) is a technique for management of ureteropelvic junction obstruction (UPJO). PURPOSE: To report outcomes of RAP for primary and secondary (after failed primary treatment) UPJO. MATERIALS AND METHODS: Single institution data of adult RAP performed from 2007 to 2009 was collected retrospectively following approval by our IRB. Database analysis included patient age, race, pre and post-operative imaging studies and perioperative variables including operative time, blood loss, pain and complications. RESULTS: Fifty-five adult patients underwent RAP (26 left/29 right) for UPJO including 9 secondary procedures from 2007 to 2009. Average follow-up was 16 months (1-36). Mean age was 41 years (18-71) with an average BMI of 27 (17-42); 32 were female. Most patients were diagnosed with preoperative diuretic renal scintigraphy and the obstructed side demonstrated mean function of 41% and t1/2 of 70 minutes. Mean operative time was 194 minutes with average blood loss less than 100 mL. Mean hospital stay was 1.7 days with an average narcotic equivalent dose of 15 mg. RAP for secondary UPJO took longer with more blood loss and had a lower success rate. Failure was defined as the need of another procedure due to persistent pain and/or obstruction after diuretic renal imaging. One patient (2%) with primary UPJO failed and 2 patients (22%) with secondary UPJO failed. One major complication occurred. CONCLUSION: RAP is a good option for the treatment of patients with UPJO. Reported series have established that endopyelotomy has inferior success rate for the treatment of primary UPJO which compromises the success of subsequent treatment as demonstrated in our higher failure rate with secondary UPJO repair.

Surgical outcomes of robot-assisted partial nephrectomy.

• Robot-assisted partial nephrectomy (RAPN) has emerged as a viable technique for nephron-sparing surgery. • In this article, we review the outcomes of RAPN in its current iteration, with attention to operative, oncological, and functional outcomes. In addition, we highlight techniques that may serve to enhance outcomes.

Robot-assisted partial nephrectomy: evolution and recent advances.

PURPOSE OF REVIEW: Robot-assisted partial nephrectomy (RAPN) is emerging as a viable complement to traditional laparoscopic and open partial nephrectomy. As a relatively new technique, the techniques and technologies employed during RAPN continue to evolve. In the present article, we provide an overview of the evolution of robot-assisted renal surgery, and highlight the recent advances that have helped to bring RAPN to the fore. RECENT FINDINGS: The learning curve for RAPN appears to be slight, and technical proficiency may be quickly achieved, even for those with limited laparoscopic experience. Recent advances include improvements in ergonomics of the robotic system itself, as well as the introduction of sliding-clip renorrhaphy, early unclamping techniques, and off-clamp techniques. Early-to-intermediate outcomes are very promising, demonstrating short warm ischemic times, and a low rate of complication and recurrence. Disadvantages to the approach include substantial cost, as well as increased reliance upon the assistant to perform critical maneuvers. SUMMARY: Robot-assisted partial nephrectomy appears to be a safe and efficacious technique for the surgical management of localized renal malignancy. Recent developments have focused upon reducing ischemic insult, as well as decreasing reliance upon the assistant.

Robot assisted partial nephrectomy versus laparoscopic partial nephrectomy for renal tumors: a multi-institutional analysis of perioperative outcomes.

PURPOSE: Robot assisted partial nephrectomy is rapidly emerging as an alternative to laparoscopic partial nephrectomy for the treatment of renal malignancy. We present the largest multi-institution comparison of the 2 approaches to date, describing outcomes from 3 experienced minimally invasive surgeons. MATERIALS AND METHODS: We performed a retrospective chart review, evaluating 118 consecutive laparoscopic partial nephrectomies and 129 consecutive robot assisted partial nephrectomies performed between 2004 and 2008 by 3 experienced minimally invasive surgeons at 3 academic centers. Perioperative data were recorded along with clinical and pathological outcomes. RESULTS: The robot assisted and laparoscopic partial nephrectomy groups were equivalent in terms of age, gender, body mass index, American Society of Anesthesiologists classification (2.3 vs 2.4) and radiographic tumor size (2.9 vs 2.6 cm), respectively. Comparison of operative data revealed no significant differences in terms of overall operative time (189 vs 174 minutes), collecting system entry (47% vs 54%), pathological tumor size (2.8 vs 2.5 cm) and positive margin rate (3.9% vs 1%) for robot assisted and laparoscopic partial nephrectomy, respectively. Intraoperative blood loss was less for robot assisted vs laparoscopic partial nephrectomy (155 vs 196 ml, p = 0.03) as was length of hospital stay (2.4 vs 2.7 days, p <0.0001). Warm ischemia times were significantly shorter in the robot assisted partial nephrectomy series (19.7 vs 28.4 minutes, p <0.0001). Subset analysis based on complexity revealed that tumor complexity had no effect on operative time or estimated blood loss for robot assisted partial nephrectomy, although complexity did affect these factors for laparoscopic partial nephrectomy. In addition, for simple and complex tumors robot assisted partial nephrectomy provided significantly shorter warm ischemic time than laparoscopic partial nephrectomy (15.3 vs 25.2 minutes for simple, p <0.0001; 25.9 vs 36.7 minutes for complex, p = 0.0002). There were no intraoperative complications during robot assisted partial nephrectomy vs 1 complication during laparoscopic partial nephrectomy. Postoperative complication rates were similar for robot assisted and laparoscopic partial nephrectomy (8.6% vs 10.2%). CONCLUSIONS: Robot assisted partial nephrectomy is a safe and viable alternative to laparoscopic partial nephrectomy, providing equivalent early oncological outcomes and comparable morbidity to a traditional laparoscopic approach. Moreover robot assisted partial nephrectomy appears to offer the advantages of decreased hospital stay as well as significantly less intraoperative blood loss and shorter warm ischemia time, the latter of which may help to provide maximal preservation of renal reserve. In addition, operative parameters for robot assisted partial nephrectomy appear to be less affected by tumor complexity compared to laparoscopic partial nephrectomy. Interestingly while the advantages of robotic surgery have historically been believed to aid laparoscopic naïve surgeons, these data indicate that robot assisted partial nephrectomy may also benefit experienced laparoscopic surgeons.

The role of nephron-sparing robotic surgery in the management of renal malignancy.

PURPOSE OF REVIEW: Robotic-assisted partial nephrectomy is an emerging technique for the treatment of renal malignancy. Our aim is to review the initial reported experience with robotic partial nephrectomy, evaluating techniques, early outcomes, and potential advantages of the robotic approach over the traditional laparoscopic approach. RECENT FINDINGS: Early experience with robotic partial nephrectomy demonstrates good oncologic outcomes. Other parameters, such as operative time, blood loss, postoperative renal function, and hospital stay, appear to be at least equivalent to laparoscopic partial nephrectomy. New techniques, including refined methods for renorrhaphy, have also been introduced which aim to simplify critical portions of the procedure, although vascular clamping still remains a challenging aspect of the procedure. The learning curve appears to be slight, even for surgeons without extensive laparoscopic experience. SUMMARY: Although long-term outcome data is presently lacking, the early experience with robotic partial nephrectomy shows promise. The technique should continue to evolve as it gains acceptance as an alternative to the traditional laparoscopic approach.

Approach to the small renal mass: weighing treatment options.

The increased detection of incidental renal masses has introduced new challenges into the management of patients with newly discovered renal masses. Much interest has been focused on the diagnostic accuracy and the prognostic ability of imaging studies. These studies have elucidated trends that can guide management but remain woefully inaccurate for predicting the exceptions to the rule, many of which can produce untoward outcomes. Renal biopsy may aid in the management of patients with indeterminate -imaging; however, the role of biomarkers remains unclear. Active surveillance has emerged as an attractive option in certain patient populations, although the lack of reliable predictors of tumor behavior based upon currently available surveillance techniques understandably raises concerns about its propriety. For patients who would benefit from operative management, nephron-sparing procedures such as ablation and partial nephrectomy have gained increasing acceptance as an alternative to radical nephrectomy.

Robotic-assisted partial nephrectomy: surgical technique using a 3-arm approach and sliding-clip renorrhaphy.

INTRODUCTION: For the treatment of renal tumors, minimally invasive nephron-sparing surgery has become increasingly performed due to proven efficiency and excellent functional and oncological outcomes. The introduction of robotics into urologic laparoscopic surgery has allowed surgeons to perform challenging procedures in a reliable and reproducible manner. We present our surgical technique for robotic assisted partial nephrectomy (RPN) using a 3-arm approach, including a sliding-clip renorrhaphy. MATERIALS AND METHODS: Our RPN technique is presented which describes the trocar positioning, hilar dissection, tumor identification using intraoperative ultrasound for margin determination, selective vascular clamping, tumor resection, and reconstruction using a sliding-clip technique. CONCLUSION: RPN using a sliding-clip renorrhaphy is a valid and reproducible surgical technique that reduces the challenge of the procedure by taking advantage of the enhanced visualization and control afforded by the robot. The renorrhaphy described is performed under complete control of the console surgeon, and has demonstrated a reduction in the warm ischemia times in our series.

Bacterial prostatitis.

Prostatitis is perhaps the most common urologic complaint in men younger than 50 years of age and affects 11% to 16% of American men over the course of their lifetimes. Prostatitis syndromes have a significant psychologic impact upon patients who suffer from them and place an enormous financial strain upon the health care system. Despite many advances in our understanding of the pathogenesis and treatment of prostatitis, current management strategies are unable to provide a significant portion of relief from symptoms. In this article, we focus on bacterial prostatitis (types I and II), with an emphasis on new understandings of pathogenesis, diagnosis, and treatment strategies for these often challenging patients.

The role of the assistant during robot-assisted partial nephrectomy: does experience matter?

The objective of this study was to evaluate surgical outcomes with respect to the experience level of the bedside assistant during robot-assisted partial nephrectomy. A retrospective review was conducted of a prospectively maintained database of 414 consecutive robot-assisted laparoscopic partial nephrectomies performed by experienced robotic surgeons at our institution from April 2011 to September 2014. A senior-level assistant was defined as a resident in his or her post-graduate year (PGY) 4 or 5, or a fellow. Junior-level assistants were considered to be PGY-2, PGY-3, or a nurse first assistant. Multivariate analyses were performed using linear, Poisson, and logistic regression models. There were 115 junior-level cases and 299 senior-level cases. On univariate analysis, the experience level of the assistant had no impact on operative time (168 for junior level vs. 163 min for senior level, p = 0.656). Likewise, there were no differences between the junior- and senior-level groups with regard to warm ischemia time (21.3 vs. 20.9 min, p = 0.843), negative margin status (111/115 (96.5 %) vs. 280/299 (93.6 %), p = 0.340), or postoperative complications (17/115 (14.8 %) vs. 35/299 (11.7 %), p = 0.408). After multivariate analysis, operative time was associated with increased body mass index and tumor size (both p < 0.001), but not with resident experience level (p = 0.051). Estimated blood loss and postoperative complications were also not associated with the PGY of the assistant (p = 0.488 and p = 0.916, respectively). Despite common concern, the PGY status of a physician trainee serving as the bedside assistant does not appear to influence the outcomes of robot-assisted partial nephrectomy at a high-volume center.

Is extended preoperative antibiotic prophylaxis for high-risk patients necessary before percutaneous nephrolithotomy?

PURPOSE: The goal of this study was to compare the rate of systemic inflammatory response syndrome (SIRS) in high-risk patients undergoing percutaneous nephrolithotomy (PCNL) between patients who received 7, 2, or 0 days of preoperative antibiotics. MATERIALS AND METHODS: We retrospectively reviewed a series of consecutive PCNLs performed at our institution. Patients with infected preoperative urine cultures were excluded. High-risk patients were defined as those with a history of previous urinary tract infection (UTI), hydronephrosis, or stone size ≥2 cm. Patients were treated with 7, 2, or 0 days of preoperative antibiotic prophylaxis prior to PCNL. All patients received a single preoperative dose of antibiotics within 60 minutes of the start of surgery. Fisher exact test was used to compare the rate of SIRS by preoperative antibiotic length. RESULTS: Of the 292 patients identified, 138 (47.3%) had sterile urine and met high-risk criteria, of which 27 (19.6%), 39 (28.3%), and 72 (52.2%) received 7, 2, and 0 days of preoperative antibiotics, respectively. The 3 groups were similar in age, sex, and duration of surgery (p>0.05). There was no difference in the rate of SIRS between the groups, with 1 of 27 (3.7%), 2 of 39 (5.1%) and 3 of 72 patients (4.2%) meeting criteria in the 7, 2, and 0 days antibiotic groups (p=~1). CONCLUSIONS: Extended preoperative antibiotic prophylaxis was not found to reduce the risk of SIRS after PCNL in our institutional experience of high-risk patients. For these patients, a single preoperative dose of antibiotics is sufficient.

Electronic nutritional intake assessment in patients with urolithiasis: A decision impact analysis.

PURPOSE: To evaluate a physician's impression of a urinary stone patient's dietary intake and whether it was dependent on the medium through which the nutritional data were obtained. Furthermore, we sought to determine if using an electronic food frequency questionnaire (FFQ) impacted dietary recommendations for these patients. MATERIALS AND METHODS: Seventy-six patients attended the Stone Clinic over a period of 6 weeks. Seventy-five gave consent for enrollment in our study. Patients completed an office-based interview with a fellowship-trained endourologist, and a FFQ administered on an iPad. The FFQ assessed intake of various dietary components related to stone development, such as oxalate and calcium. The urologists were blinded to the identity of patients' FFQ results. Based on the office-based interview and the FFQ results, the urologists provided separate assessments of the impact of nutrition and hydration on the patient's stone disease (nutrition impact score and hydration impact score, respectively) and treatment recommendations. Multivariate logistic regressions were used to compare pre-FFQ data to post-FFQ data. RESULTS: Higher FFQ scores for sodium (odds ratio [OR], 1.02; p=0.02) and fluids (OR, 1.03, p=0.04) were associated with a higher nutritional impact score. None of the FFQ parameters impacted hydration impact score. A higher FFQ score for oxalate (OR, 1.07; p=0.02) was associated with the addition of at least one treatment recommendation. CONCLUSIONS: Information derived from a FFQ can yield a significant impact on a physician's assessment of stone risks and decision for management of stone disease.

Review of robot-assisted partial nephrectomy in modern practice.

Partial nephrectomy (PN) is currently the standard treatment for T1 renal tumors. Minimally invasive PN offers decreased blood loss, shorter length of stay, rapid convalescence, and improved cosmesis. Due to the challenges inherent in laparoscopic partial nephrectomy, its dissemination has been stifled. Robot-assisted partial nephrectomy (RAPN) offers an intuitive platform to perform minimally invasive PN. It is one of the fastest growing robotic procedures among all surgical subspecialties. RAPN continues to improve upon the oncological and functional outcomes of renal tumor extirpative therapy. Herein, we describe the surgical technique, outcomes, and complications of RAPN.

In vivo evaluation of a reverse thermosensitive polymer for ureteroscopy with laser lithotripsy: porcine model.

PURPOSE: To evaluate the effects of a reverse thermosensitive polymer during ureteroscopy with laser lithotripsy in an in vivo porcine model. MATERIALS AND METHODS: Six pigs underwent general anesthesia followed by bilateral ureteroscopy with laser lithotripsy of stone phantoms while measuring intrapelvic renal pressures through bilateral nephrostomy tubes. The procedures were performed in one ureter with the reverse thermosensitive polymer and in the contralateral, control ureter without the reverse thermosensitive polymer. Stone migration lengths, operative times, laser times, laser energy usage, intrapelvic pressures, and postnecropsy histologic examinations of the ureters were compared between the two groups. RESULTS: Bilateral ureteroscopy with lithotripsy was successfully performed in five of six pigs. In one pig, only the unilateral control was performed, because the ureter was too narrow to complete the contralateral side. The mean laser time was 12.8 minutes shorter with the use of the reverse thermosensitive polymer group than in the controls (P=0.021). The procedure time, laser energy usage, and retropulsion length was shorter in the reverse thermosensitive polymer group, but did not reach significance. Between the two groups, there was no difference in mean renal pelvic pressures, peak renal pelvic pressures, or postprocedure histologic examinations of the ureters. CONCLUSIONS: The use of a reverse thermosensitive polymer during ureteroscopy with lithotripsy may have greater advantages beyond preventing stone retropulsion. Here, the use of a reverse thermosensitive polymer during ureteroscopy with lithotripsy resulted in a significant decrease in laser times. Further clinical investigations could further delineate the advantages of using a reverse thermosensitive polymer during intracorporeal lithotripsy.

Gas-producing renal infection presenting as pneumaturia: a case report.

We present a case of persistent pneumaturia of one-year duration in a fifty-five-year-old male with a history of spinal cord injury. The evaluation demonstrated gas throughout the collecting system attributable to a urinary tract infection with a gas-forming organism, Klebsiella pneumoniae.

Endoscopic management of genitourinary foreign bodies.

Retrieval of foreign bodies from the genitourinary system, most commonly inserted for sexual satisfaction or as a result of a psychiatric illness, can pose a significant surgical challenge. Due to their breadth of size, shape, and location within the genitourinary system, endoscopic management can be difficult. Here, we review the management of four cases of foreign object insertion into the genitourinary system and their outcomes and management.

2D versus 3D visualization: impact on laparoscopic proficiency using the fundamentals of laparoscopic surgery skill set.

INTRODUCTION: We compared the impact of two-dimensional (2D) versus three-dimensional (3D) visualization on both objective and subjective measures of laparoscopic performance using the validated Fundamentals of Laparoscopic Surgery (FLS) skill set. SUBJECTS AND METHODS: Thirty-three individuals with varying laparoscopic experience completed three essential drills from the FLS skill set (peg transfer, pattern cutting, and suturing/knot tying) in both 2D and 3D. Participants were randomized to begin all tasks in either 2D or 3D. Time to completion and number of attempts required to achieve proficiency were measured for each task. Errors were also noted. Participants completed questionnaires evaluating their experiences with both visual modalities. RESULTS: Across all tasks, greater speed was achieved in 3D versus 2D: peg transfer, 183.4 versus 245.6 seconds (P<.0001); pattern cutting, 167.7 versus 209.3 seconds (P=.004); and suturing/knot tying, 255.2 versus 329.5 seconds (P=.031). Fewer errors were committed in the peg transfer task in 3D versus 2D (P=.008). Fourteen participants required multiple attempts to achieve proficiency in one or more tasks in 2D, compared with 7 in 3D. Subjective measures of efficiency and accuracy also favored 3D visualization. The advantage of 3D vision persisted independent of participants' level of technical expertise (novice versus intermediate/expert). There were no differences in reported side effects between the two visual modalities. Overall, 87.9% of participants preferred 3D visualization. CONCLUSIONS: Three-dimensional vision appears to greatly enhance laparoscopic proficiency based on objective and subjective measures. In our experience, 3D visualization produced no more eye strain, headaches, or other side effects than 2D visualization. Participants overwhelmingly preferred 3D visualization.

Laparoscopic cryoablation of renal masses: single-center long-term experience.

OBJECTIVE: To evaluate perioperative and long-term functional and oncological outcomes of laparoscopic cryoablation (LCA) performed at Washington University. METHODS: A retrospective chart review was performed evaluating 62 consecutive patients who underwent LCA at our institution between 2000 and 2005. RESULTS: Mean age-adjusted Charlson Comorbidity Index (CCI) was 6.1 (SD, 2.1; 95% confidence interval [CI], 5.6-6.6). Mean tumor size was 2.52 cm (SD, 0.99; CI, 2.3-2.8). Mean operative time was 162.0 minutes (SD, 66.6; CI, 142.0-182.1). Mean estimated blood loss was 84.9 mL (SD, 102; CI, 58.6-111.2). Mean hospital stay was 2.6 days (SD, 1.90; CI, 2.1-3.1). The perioperative complication rate was 9.7% (Clavien 1-2). Among patients with biopsy proven, localized renal cell carcinoma, the 6-year Kaplan-Meier estimated disease-free survival (DFS) was 80%; cancer-specific survival (CSS) was 100%; and overall survival (OS) was 76.2%. Mean follow-up in this subset was 76.0 months (SD, 39.3; CI, 62.7-89.4; n = 35), whereas mean time to cancer recurrence was 27.6 months (SD, 11.2; CI, 15.9-39.3; n = 6). Tumor size ≥2.6 cm was the only predictor of cancer recurrence in a multivariate Cox proportional hazards model (hazard ratio [HR] = 28.9; P = .046; n = 35). Mean preoperative estimated glomerular filtration rate (eGFR) was 68.3 (SD, 22.3; CI, 62.1-74.5), compared to 64.5 mL/min/1.73 m(2) (SD, 28.9; CI, 56.5-72.6) at last follow-up (P = .12; n = 52). Excluding patients requiring secondary ablative or extirpative treatments for recurrent renal cell carcinoma, preoperative eGFR <60 mL/min/1.73 m(2) (odds ratio [OR] = 88.3; P = .036) and age-adjusted CCI ≥6 (OR = 32.4; P = .046) were the only factors predicting renal disease progression on multiple logistic regression (n = 47). CONCLUSION: We report what is by far the longest follow-up to date of postlaparoscopic cryoablation changes in eGFR and note excellent long-term renal functional outcomes. For those willing to accept the potential need for retreatment for recurrent disease, LCA offers excellent long-term CSS.