Renal and Ureteric Stone Composition: A five year retrospective study for Northern Ireland.

INTRODUCTION: The study aimed to present the types of renal and ureteric stones (calculi) present in the population of Northern Ireland. The data may help in future planning treatment of stone services, patient education and prevention. METHODS: Consecutive retrospective renal and ureteric stones analysed over 5.75 years (January 2008 - September 2013) in Northern Ireland. Exclusions included patients < 16 years, and calculi listed as bladder stone. RESULTS: Total of 1618 stones analysed. Male to female calculi ratio 1.93: 1. Age range 16 - 94 years (52.2 mean), most common age for stone analysis 31-60 years. From 2008 to 2012 the number of stones analysed increased by 132.9%. Calcium was demonstrated in 94.5% (1529) of stones, of which 2.5% (40) pure calcium oxalate. Calcium oxalate and phosphate 72.9% (1182) of all stones, male to female ratio 2.4:1. Stones containing uric acid 9.6% (156), with uric acid male to female ratio 4.83:1. Struvite 13.7% (222), male to female ratio 1:1.6. Pure cystine 1.1% (18) of stones, male to female ratio 1:1.3. CONCLUSION: There is a high proportion (94.4%) of stones containing calcium oxalate in Northern Ireland; these patients should be aiming to produce 2L of urine a day to aid prevention. Most common age for stone analysis (31-60) is in keeping with most common age for presentation. The steep increase in calculi analysis of 132.9% must be met with personalised stone treatment and prevention strategies.

Radiofrequency Ablation of Small Renal Masses: Outcomes, Complications and Effects on Renal Function.

INTRODUCTION: To describe oncological outcomes, effects on renal function and complications with radiofrequency ablation (RFA) of T1 renal tumors in an 8-year experience. MATERIALS AND METHODS: A retrospective study of RFA in 89 consecutive patients between 2005 and 2013 was undertaken. Those with metastatic disease, incomplete follow-up, genetic pre-disposition to renal tumors and biopsy proven benign pathology were excluded, with 79 patients meeting inclusion criteria. Data was collected on demographics, oncological outcomes, complications and effects on renal function. RESULTS: We demonstrate 94% disease-free survival at median follow-up of 29 months in a population consisting of 42 T1a and 37 T1b tumors. No disease related deaths were recorded in the follow-up period. Post-RFA decline in renal function was shown to correlate with tumor size and increased age (p = 0.0009/0.0021). Pre-existing renal impairment was a risk for post-RFA function decline (p < 0.005). Two complications were encountered in the series. CONCLUSION: RFA produces durable oncological outcomes in T1 tumors with a minimal effect on renal function and low risk of complications. Patients at risk of developing renal impairment can be identified from described risk factors.

Radiofrequency ablation of renal cell carcinoma: a follow up of outcomes.

INTRODUCTION: To present the oncological outcomes in a series of patients with cT1a renal cell carcinoma (RCC) treated with radiofrequency ablation (RFA) and its effect on the glomerular filtration rate (GFR). MATERIALS AND METHODS: Forty-five patients (48 renal units) treated at the Belfast City Hospital, over 4 years. Average age is 61.5 years (range 41-80). Eighteen patients (22 renal units) were included with American Society of Anesthesiologists (ASA) II and III. The rest were ASA I. Average tumor size was 2.63 cm (range 1.2 cm-6 cm). Renal function before and after RFA was recorded by means of the estimated glomerular filtration rate (eGFR) and the changes are presented. Oncological outcomes were established from follow up imaging. A satisfactory response was defined by disappearance or a persistence of non-enhancing lesion of smaller size at follow up. A partial response was defined by a persistent but non-enhancing similar size lesion. A failed response was defined by enlarging or persistently enhancing lesions. RESULTS: Mean follow up was 30.6 months (4-60 months). A good response was found in 33 (74%) patients. A partial response was found in 3 (8%) patients and failed response was identified in 8 (18%) patients. The average reduction in eGFR was 11 mL/min. Two patients had a 50% reduction in their eGFR. No patient required dialysis following treatment. CONCLUSION: RFA presents safe treatment choice for patients with RCC, particularly those that are high risk surgical candidates and those who refuse surgery. Short term results suggest good oncological outcomes and preservation of renal function.

Outcome of glansectomy and skin grafting in the management of penile cancer.

Purpose. To report outcome data for patients with penile cancer treated surgically with glansectomy and skin grafting. Materials and Methods. We retrospectively reviewed data on all patients undergoing surgical management of penile cancer by a single surgeon between 1998 and 2008. Outcomes in patients who underwent glansectomy and skin grafting were analysed. Results. Between 1998 and 2008 a total of 25 patients with a mean age 60 (39-83) underwent glansectomy and skin grafting. Six patients had carcinoma in situ (CIS); the stage in the remaining patients ranged from T1G1 to T3G3. Mean followup for patients was 28 months (range 6-66). Disease specific survival was 92% with 2 patients who had positive nodes at lymph node dissection developing groin recurrence. One patient developed a local recurrence requiring a partial penectomy. Conclusions. Penile preserving surgery with glansectomy and skin grafting is a successful technique with minimal complications for local control of penile carcinoma arising on the glans. Careful followup to exclude local recurrence is required.

Subclavian vein thrombosis: an unusual presentation of renal cell carcinoma.

Subclavian vein thrombosis is an uncommon clinical condition which is often associated with venous catheterization or secondary to excessive effort. We present a 54-year-old female with subclavian vein thrombosis as a first presentation of renal cell carcinoma. Although this is an unusual presentation, malignancy should be considered in the differential diagnosis. Hypercoagulability as part of a paraneoplastic syndrome was considered a possible etiology. In patients with otherwise unexplained subclavian vein thrombosis, full systemic examination and radiological evaluation of the abdomen, retroperitoneum and pelvis should be pursued. A review of the literature relevant to this unusual case is provided.

A Review in Management of Testicular Cancer: Single Center Review.

BACKGROUND: Testicular cancer is one of the few solid cancers that can be cured even when it is metastasized with overall survival rate of more than 90%. The aim of this study was to establish the age adjusted incidence of testicular cancer and to critically assess the management of testicular tumor. METHODS: This is a quantitative retrospective study utilizing a review of clinical notes for patients who underwent testicular orchidectomy. The number of cancer cases, types of pathology and cancer staging were examined. RESULTS: There is no substantial difference between the crude and the age-standardized incidence, moreover no difference from the reported crude incidence by the Scottish intercollegiate guidelines. We found 55.1% of seminoma, 14.28% of non-seminoma and 30.61% of combined (seminoma and non-seminoma), and stage I disease in 61.22% of cases, stage II in 36.73% of cases, and stage IV in 2.04% of cases. Most of the cancers were in the age group 20 - 50 with the majority (48.97%) in the age group 31 - 40. About 42.85% of cases were identified with high tumor markers; higher percentage of seminoma at stage II (40.74%). CONCLUSIONS: There is no substantial difference between the crude and the age-standardized incidence, moreover no difference from the reported crude incidence. Most of the cancers were in the age group 20 - 50 with the majority (48.97%) in the age group 31 - 40. Only 25% of seminomas had elevated tumor markers. Moreover, it is important to re-enforce strict adaptation to the IGCCCG prognostic factor-based classifications.