Operating Endoscopically with "Two Hands" to Remove Calcified Permanent Suture After Pyeloplasty.

We describe a combined percutaneous and endoscopic approach to remove encrusted permanent suture in the renal pelvis that was placed during pyeloplasty repair. Our index patient had a laparoscopic dismembered pyeloplasty at an outside institution 10 years before presenting with flank pain and nondependent nephrolithiasis. This proved to be an encrusted permanent suture material. There is limited data on incidence of nephrolithiasis after ureteropelvic junction repair, but it is well documented that nonabsorbable suture lines should be avoided in the urinary tract as they may serve as a nidus for stone formation.

Use of the Modification of Diet in Renal Disease Equation for Estimating Glomerular Filtration Rate in the Urologic Literature.

PURPOSE: To evaluate the use of the modification of diet in renal disease (MDRD) equation in the urologic literature and the degree to which it is used appropriately. METHODS: Medline was queried searching the title, keywords, or abstract of seven urology journals for the exact phrases "MDRD" or "modification of diet in renal disease." Forty-seven articles published between 2004 and 2013 met the inclusion criteria and were reviewed. Each article was reviewed in its entirety and graded on the appropriateness of its use of MDRD to estimate glomerular filtration rate (GFR). Inappropriate use was defined as using the MDRD equation to make comparisons or conclusions about true renal function with the majority of estimated glomerular filtration rate (eGFR) values >60 mL/min per 1.73 m(2). RESULTS: Of the 47 articles reviewed, 17 (36%) were Grade 1 (appropriate use of MDRD), 20 (43%) were Grade 2 (inappropriate use of MDRD but not critical to claims of article), and 10 (21%) were Grade 3 (inappropriate use of MDRD). Of the Grade 3 articles, only 40% (4 of 10) acknowledged the limitations of this equation for estimating GFR. CONCLUSIONS: The majority of articles using the MDRD equation to estimate GFR did so using values where the estimate is quite unstable (eGFR >60 mL/min per 1.73 m(2)), thereby limiting the validity of the claims. Urologists should reconsider the use of MDRD for comparing estimates of GFR in patients with normal renal function in published articles.

Fibromuscular Dysplasia in a Normotensive Patient Presented With Renal Infarct: Case Report and Endovascular Technique.

Fibromuscular dysplasia (FMD) is a well-known disease, but its diagnosis can be challenging. Typically, the symptomatic FMD are reported by young and middle aged people with high blood pressure refractory to medical treatment. We present a rare case of a young, healthy, and normotensive patient who presented with pain secondary to renal infarction, without any prior signs or symptoms or history of hypertension. This presentation of FMD has not been previously described. The typical but subtle angiographic findings of the macro-aneurysmal FMD as well as the successful endovascular treatment are discussed herein. The macro-aneurysmal form of FMD should be considered in the differential diagnosis of acute renal infarction in young and middle aged patients even if they do not have a history of hypertension.

Intermediate-term outcomes after renal cryoablation: results of a multi-institutional study.

PURPOSE: To present intermediate-term oncologic efficacy of cryoablation (CA) for the treatment of patients with small renal masses in a multi-institution multisurgeon cohort. PATIENTS AND METHODS: We retrospectively reviewed billing records and tumor registries, identifying 116 renal tumors in 116 patients treated with CA by six surgeons at four institutions. Patient age, sex, tumor size, RENAL nephrometry score, complications, and recurrences were recorded. RESULTS: One hundred-sixteen patients (66.4% male, 33.6% female) with 116 tumors underwent renal mass CA with a mean follow-up of 27.4 months (range 1-112 mos). Mean tumor size was 2.76 ± 0.97 cm (range 1.1-5.5 cm). Twenty-seven complications occurred in 23 patients for an overall complication rate of 19.8%. Low-grade complications (Clavien I and II) accounted for 92.6% (n=25) of overall complications. Seven (6%) patients had enhancement on initial imaging and were considered incomplete ablations. Local recurrence and metastatic disease developed in four and one patients, respectively. In patients with biopsy-proven renal-cell carcinoma (RCC), the 2- and 5-year recurrence-free survival (RFS) probability was 0.83 (95% confidence interval [CI]: 0.74, 0.95) and 0.77 (95% CI: 0.60, 0.94), respectively. After excluding biopsy proven RCC patients with incomplete ablations, the 2- and 5-year RFS increased to 0.91 (95% CI: 0.82, 1.00) and 0.85 (95% CI: 0.71, 1.00) respectively. CONCLUSION: CA of renal masses results in acceptable oncologic efficacy accompanied by a tolerable complication profile in a cohort with a mean follow-up of 27.4 months. CA remains a viable treatment option for small renal masses in selected patients.

Use of tumor necrosis factor-alpha-coated gold nanoparticles to enhance radiofrequency ablation in a translational model of renal tumors.

OBJECTIVES: Radiofrequency ablation (RFA) has been most effective when the tumors are small, exophytic, and away from vital structures. We enlarged the size of the ablation kill zone by infusing a 30-nm tumor necrosis factor-alpha and polyethylene glycol-coated gold nanoparticle (CYT-6091, CytImmune Sciences, Inc.) before ablation in a rabbit kidney tumor model. MATERIALS AND METHODS: A total of 37 New Zealand White rabbits had VX-2 tumors implanted into their bilateral kidneys; they were then split into 3 treatment groups of 10 rabbits each and a sham group of 7 rabbits as follows: (1) CYT-6091 only, (2) RFA only, (3) CYT-6091 followed 4 hours later by RFA. Gross and microscopic measurements of the ablation size as well as histologic analysis using hematoxylin and eosin staining were performed to determine the effect of CYT-6091 on the ablation. RESULTS: The RFA + CYT-6091 group had a larger zone of complete cell death than the RFA-only group when measured on microscopic examination (0.30 +/- 0.07 vs 0.23 +/- 0.03 mL, P = .03). The zone of partially ablated tissue was smaller in the RFA + CYT-6091 group than in the RFA-only group (0.08 +/- 0.02 vs 0.13 +/- 0.05 mL, P = .01). CONCLUSIONS: We have demonstrated the efficacy of CYT-6091 in enhancing RFA in a translational kidney tumor model. The potential usage of CYT-6091 to improve RFA of renal cell carcinoma merits further study.

The role of radiologic imaging and biopsy in renal tumor ablation.

PURPOSE: The rate of unintentionally discovered renal masses has been increasing along with a parallel increased incidence of renal cell carcinoma both in men and women. Ablation therapy has emerged as an alternative for the treatment of these small renal tumors. Several techniques have been developed for renal tumor ablation with cryoablation (CA) and radiofrequency ablation (RFA) being among the most widely used and studied. The purpose of this article is to review the role of imaging and renal mass biopsy in renal tumor ablation with focus on CA and RFA. METHODS: We performed a PubMed database search from January 2000 to January 2010 using the terms: renal tumor ablation, renal biopsy, indications, imaging, computed tomography (CT) guided, magnetic resonance imaging (MRI) guided and ultrasound (US) guided. CONCLUSION: Nephron-sparing procedures, such as cryoablation and RFA, offer an adequate treatment option for selected patients. Imaging techniques such as ultrasonography, CT and MRI are critical to targeting thermal ablation of renal masses. Intra-operative biopsy prior to treatment is becoming a standard procedure but controversy remains regarding pre-operative biopsy. Additionally, contradictory data exist on the value of post-ablation biopsy.

Resorbable clip migration in the collecting system after laparoscopic partial nephrectomy.

A complication is reported in which Lapra-Ty absorbable suture clips (Ethicon EndoSurgery) migrated from a laparoscopic partial nephrectomy bed into the collecting system, causing renal colic. During surgery performed with hilar occlusion, visual inspection did not reveal collecting system entry. Transected vessels were oversewn with absorbable suture secured with Lapra-Tys. Absorbable bolsters were placed in the parenchymal bed, and compression sutures secured with Lapra-Tys were placed through the renal capsule. Six weeks postoperatively, the patient developed ipsilateral renal colic, and computed tomography demonstrated several 3-mm opacities within the ureter. After 2 weeks of conservative management, he spontaneously passed several Lapra-Ty clips.