Primary renal lymphoma: an unusual finding following radical nephrectomy.

Secondary kidney involvement by disseminated non-Hodgkin's lymphoma (NHL) is quite common and is estimated to approach 30 - 60% in NHL patients. However, primary renal lymphoma is exceedingly rare and estimated to make up less than 1% of all kidney masses. We report a case of primary renal NHL presenting with profound hypercalcemia and renal failure recalcitrant to medical management, ultimately treated with urgent radical nephrectomy. To our knowledge, this is the first report of primary renal lymphoma presenting in this acute fashion.

Does Omission of Ureteral Stents Increase Risk of Unplanned Return Visit? A Systematic Review and Meta-Analysis.

PURPOSE: Post-ureteroscopy ureteral stent omission remains controversial. Although omission is associated with reduced postoperative discomfort, concern remains for early obstruction. We performed a systematic review and meta-analysis of trials to compare the risk of unplanned visits with vs without a stent following ureteroscopy for nephrolithiasis. MATERIALS AND METHODS: Randomized, controlled trials and observational studies comparing post-ureteroscopic stent omission vs placement and reporting unplanned visits within 30 days were identified via a search of MEDLINE® (1946 to 2015), CENTRAL (Cochrane Central Register of Controlled Trials, 1898 to 2015), Embase® (1947 to 2015), ClinicalTrials.gov (1997 to 2015), AUA (American Urological Association) Annual Meeting abstracts (2011 to 2015) and reference lists of included articles as last updated in October 2015. Two reviewers independently extracted data and assessed methodological quality. ORs, RRs and weighted mean differences were calculated as appropriate for each outcome. RESULTS: Of the initial 1,992 studies 17 in a total of 1,943 participants met inclusion criteria. Unstented patients were significantly more likely to have an unplanned medical visit compared to those who received a post-ureteroscopy stent (OR 1.63, 95% CI 1.15-2.30). Unstented patients had shorter operative time (weighted mean difference -3.19 minutes, 95% CI -5.64--0.74) and were less likely to experience dysuria (RR 0.39, 95% CI 0.25-0.62). They were also less likely to experience postoperative infection (OR 0.89, 95% CI 0.59-1.33) and pain (OR 0.64, 95% CI 0.39-1.05), although these results were not significant. CONCLUSIONS: Stent omission is associated with an increased risk of unplanned medical visits despite reduced symptoms compared to those in stented patients. Patients and physicians should weigh these trade-offs when considering post-ureteroscopy stent placement.

Predictors of Facility Discharge, Range of Motion, and Patient-Reported Physical Function Improvement After Primary Total Knee Arthroplasty: A Prospective Cohort Analysis.

BACKGROUND: Patients are discharged to home or inpatient settings after primary unilateral total knee arthroplasty (TKA). Few studies have compared patient outcomes following these 2 rehabilitation models for TKA patients. We identified predictors of inpatient discharge, 3-month postoperative range of motion (ROM), and 3-month postoperative patient-reported physical function improvement (Veterans RAND 12-Item Physical Component Score [PCS]) between these discharge settings. METHODS: We studied prospectively collected cohort data for 738 TKAs between April 2011 and April 2013 at a high-volume tertiary academic medical center in a rural setting. All patients followed a standardized care pathway that involved prospective data collection as part of routine clinical care. Adjusting variables included age, sex, preoperative PCS, surgeon, modified Charlson Comorbidity Index, preoperative body mass index, laterality, and preoperative ROM; the 3-month models also included length of stay and discharge disposition as adjusters. RESULTS: Significant adjusted predictors of inpatient discharge included older age, female sex, surgeon, comorbidity, lower PCS, and body mass index greater than 40. Only lower preoperative ROM predicted postoperative ROM. Inpatient discharge and higher preoperative PCS predicted lower PCS improvement. Home-based rehabilitation was associated with greater 3-month PCS improvement and showed no difference with 3-month ROM. CONCLUSION: Discharge to home-based rehabilitation after TKA, rather than inpatient facility, is associated with higher physical function at 3 months postsurgery and shows no difference with 3-month ROM. Total knee arthroplasty inpatient discharge should be based on patient care requirements rather than perceived benefit of improved ROM and physical function.