Robotic-assisted laparoscopic partial nephrectomy vs. laparoscopic and open partial nephrectomy: A single-site, two-surgeon, retrospective cohort study.

INTRODUCTION: In 2019, our center attempted to transition all partial nephrectomies (PNs) to robotic-assisted laparoscopic PN (RALPN). The purpose of this study was to compare RALPN outcomes to laparoscopic PN (LPN) and open PN (OPN) at our institution, as there is limited literature from Canadian centers. METHODS: In this single-center, two-surgeon, retrospective cohort study, we compared RALPN outcomes during the early phase of our robotics program to OPN and LPN performed just before the introduction of RALPN. RESULTS: A total of 106 patients underwent OPN, 83 LPN, and 82 RALPN during the study period. Median RALPN RENAL score was 7 vs. 6 for LPN (p<0.05) and 8 for OPN (p=0.10). Median RALPN length of stay (LOS) was two days vs. three and four days for LPN and OPN (p<0.05), respectively. OPN median procedure time was 104 minutes vs. 94 and 82 minutes for LPN and RALPN (p<0.05), respectively. Median OPN operating room (OR) time was 160 minutes vs. 150 and 146 minutes for LPN and RALPN (p<0.05), respectively. There were no significant differences in intraoperative (p=0.92) or postoperative complications rates (p=0.47). RALPN warm ischemia time (WIT) was 17 minutes vs 14.5 and 15 minutes for OPN and LPN (p<0.05), respectively. Median RALPN estimated blood loss (EBL) was 165 ml vs. 250 ml for OPN (p<0.05) and 125 ml for LPN (p=0.15). CONCLUSIONS: Although patients who underwent RALPN had longer WIT, they had similar rates of complications, required less total OR time, and had shorter procedure time and LOS compared with OPN and LPN despite similar RENAL score compared to OPN and greater score than LPN.

Septic and febrile kidney stone presentations during the COVID-19 pandemic What is the effect of reduced access to care during pandemic restrictions?

INTRODUCTION: During the early stages of the COVID-19 pandemic, hospitals shifted their resources and focus toward COVID-19 care and non-deferrable conditions. Renal colic is one of the most common urologic presentations to the emergency department (ED ). In our study, we examined whether there was an increase in septic/febrile stone presentations to the ED requiring ureteral stent insertion after the public health restrictions during the COVID-19 pandemic. METHODS: We carried out a retrospective cohort study and reviewed charts of septic/febrile stone patients requiring ureteral stent insertion from January 1, 2019, to March 16, 2020 (pre-COVID) and July 1, 2020, to December 31, 2021 (intra-COVID) at the Queen Elizabeth II Health Sciences Centre in Halifax, NS. The incidence of septic/febrile stone presentation, baseline characteristics, and perioperative outcomes were captured. RESULTS: There were 54 patients in the pre-COVID group and 74 patients in the intra- COVID group. There were no statistically significant differences found in baseline or stone characteristics between the two groups (p>0.05). Patients in the intra-COVID group were found to have a longer presentation to operating room time when compared to the pre- COVID cohort (U=961.00, p=0.04). The intra-COVID group had 20 more cases of septic stone presentations compared to the pre-COVID group at the 15-month mark (pre-COVID, n=54; intra-COVID, n=74). CONCLUSIONS: We found increased time to operative intervention in the intra-COVID cohort compared to the pre-COVID cohort. The overall number of urgent and/or critically ill ureteric stone patients increased between cohorts but was not statistically significant.

A comparison of the sarcopenic effect of androgen receptor-axis-targeted agents vs. androgen deprivation alone in patients with metastatic prostate cancer.

INTRODUCTION: Androgen deprivation therapy (ADT) with androgen receptor axis-targeted (ARAT) therapy is the standard of care provided to patients with metastatic prostate cancer. While effective, it results in sequelae, such as loss of skeletal muscle mass. In this study, we compared the sarcopenic effects of abiraterone and enzalutamide, two ARATs used to treat metastatic prostate cancer. METHODS: Our cohort was comprised of 55 patients diagnosed with metastatic hormonenaive prostate cancer from 2014-2019. Patients were divided into three treatment groups: gonadotropin-releasing hormone (GnRH ) agonist alone; GnRH agonist combined with abiraterone acetate; and GnRH agonist combined with enzalutamide. We then compared axial computed tomographic (CT) scans at the L3 level before and after the initiation of hormone therapy for each patient. A skeletal muscle index (SMI) was calculated for each patient, and alongside clinical data, was compared between the three groups. One-way analysis of variance (ANOVA) and Fisher's exact test were used to compare means and proportions, respectively. RESULTS: Baseline clinical characteristics were not significantly different between the three groups. The percent SMI change and number of newly sarcopenic patients were not found to be significantly different between the groups. The only variable that was significantly different across the three groups was time between CT scans. CONCLUSIONS: Although we found no significant difference in the sarcopenic effects of GnRH alone, GnRH with abiraterone, or GnRH with enzalutamide in our cohort of 55 hormone-naive metastatic prostate cancer patients, overall decreases in muscle mass were observed for all three groups. This highlights the importance of muscle-retaining strategies for patients undergoing ADT for metastatic prostate cancer, regardless of therapeutic regimen.

Case report: Asymptomatic renal arteriovenous fistula requiring endovascular embolization in a living donor transplanted kidney more than 15-years after last protocol biopsy.

Here we present the case of an HLA-identical living-donor kidney transplant recipient, who was incidentally found to have a large complex renal arteriovenous fistula (RAVF) in their transplanted kidney that had been present for nearly 6 years but was previously misinterpreted as being part of a collection of cysts. This patient had undergone 7 protocol biopsies of the transplanted kidney, the last of which had been performed approximately 16 years prior, representing the longest interval between most recent biopsy renal allograft to RAVF diagnosis in the literature date. This report reviews the etiology and principles of management for RAVF.

Spontaneous, atraumatic hydrocele rupture: A case report.

There is little information in the literature on the management and prognosis of ruptured hydroceles. We present a case report of spontaneous, atraumatic left hydrocele rupture in a 64-year-old male. His hydrocele was initially diagnosed as non-complex and appeared to have ruptured spontaneously three years after initial onset. On follow-up in clinic, mild re-accumulation of fluid was observed, and no pain was reported by the patient. Post-rupture fluid re-accumulation was minimal in our patient but there is potential for significant fluid re-accumulation based on other reports of ruptured hydroceles.