Disseminated blastomycosis presenting with genitourinary abscesses.

A 25 year old male presented with several weeks of fevers and testicular pain. Workup demonstrated scrotal and prostatic abscesses. Fluid from these following surgical drainage revealed Blastomyces dermatitidis. He was treated with 12 months of oral anti-fungal therapy and repeat Blastomyces urine antigen was negative at follow up. While disseminated blastomycosis most commonly presents with pulmonary and cutaneous manifestations, genitourinary symptoms are rarely seen, but important to consider.

Renal mass biopsy and thermal ablation: should biopsy be performed before or during the ablation procedure?

PURPOSE: To determine if renal mass biopsy should be performed before or during the ablation procedure with emphasis on complications and rate of ablation for renal cell carcinomas (RCC), benign tumors, and small renal masses without a histologic diagnosis. METHODS: This HIPAA-compliant, single-center retrospective study was performed under a waiver of informed consent from the institutional review board. Two hundred eighty-four consecutive patients with a small renal mass (≤4.0 cm) treated with percutaneous thermal ablation between January 2001 and January 2015 were included. Two cohorts were identified based upon the timing of renal mass biopsy: separate session two weeks prior to ablation and same session obtained immediately preceding ablation. Clinical and pathologic data were collected including risk factors for non-diagnostic biopsy. Two-sided t test, χ 2 test or Fischer's exact tests were used to evaluate differences between cohorts. Univariate and multivariate logistic regression models were constructed. RESULTS: A histologic diagnostic was achieved more frequently in the separate session cohort [210/213 (98.6%) vs. 60/71 (84.3%), p < 0.0001]. The rate of ablation of RCC was higher in the separate session group [201/213 (94.4%) vs. 46/61 (64.7%), p = 0.001]. The rate of ablation for benign tumors [14/71 (19.7%) vs. 6/213 (2.8%), p < 0.0001] and small renal masses without a histologic diagnosis [3/213 (1.4%) vs. 11/71 (15.5%), p < 0.0001] was higher in the same session cohort. There were no high-grade complications in either cohort. CONCLUSION: Performing renal mass biopsy prior to the day of ablation is safe, increases the rate of histologic diagnosis, and reduces the rate of ablation for benign tumors and small renal masses without a histologic diagnosis.

Percutaneous biopsy in large, locally advanced or metastatic renal tumors.

INTRODUCTION: The role of percutaneous biopsy to characterize large, locally advanced and metastatic primary renal tumors has not been well described. The goal of this article is to describe the potential advantages of biopsy for preoperative evaluation of patients with large renal tumors and advanced disease. METHODS: Literature was reviewed for percutaneous biopsy and for locally advanced and metastatic renal tumors. RESULTS: Multiple studies have confirmed that percutaneous biopsy is safe, and the cost is minimal relative to the cost of surgical operation. Biopsy of large masses should obtain multiple core samples from several sites with tumors to decrease error from sampling heterogeneous tumors. CONCLUSIONS: Potential advantages of biopsy for large renal masses include identification of patients for retroperitoneal lymph node dissection who may have occult lymph node metastasis. In patients with metastatic renal cell carcinoma, biopsy characterizes tumors for patients who may not benefit from cytoreductive surgical operation. The role of biopsy is likely to expand in the future with the development of advanced molecular tools for risk stratification.

A Critical Analysis of Perioperative Outcomes in Morbidly Obese Patients Following Renal Mass Surgery.

OBJECTIVE: To evaluate if body mass index (BMI) ≥ 40 is associated with risk of postoperative complications, receipt of perioperative blood transfusion (PBT), length of hospital stay (LOS), perioperative death, or hospital readmission rate following renal mass surgery. MATERIALS AND METHODS: After Institutional Review Board approval, comprehensive information was collected for patients treated with surgery for renal mass from 2000 to 2015 at one institution. Univariable and multivariable analyses were used to evaluate the association of BMI ≥ 40 among other putative risk factors for perioperative outcomes. RESULTS: A total of 1048 patients were treated surgically, including 115 (11%) with BMI > 40. Minimally invasive and open surgical approaches were used for 480 (45.8%) and 568 (54.2%) patients, respectively. Morbid obesity was not associated with risk of major complications, overall complications, receipt of PBT, LOS, hospital readmission rate, or perioperative death. Charlson comorbidity index was the only independent predictor of major complications following renal mass surgery, P = .0006, per point odds ratio 1.2 (95%C.I. 1.08-1.32). Surgical site infections (SSIs) were more common in patients with BMI ≥ 40 vs BMI < 40 (10.5% vs 4.8%, P = .01). Following multivariable analysis, BMI ≥ 40 was the only independent predictor of SSIs, odds ratio 2.6, 95% confidence interval 1.32-5.13; P = .006. CONCLUSION: Morbid obesity (BMI ≥ 40) is an independent predictor of developing SSIs following renal mass surgery. Morbid obesity is not predictive of risk for major complications, receipt of PBT, hospital readmission, perioperative death, or LOS.