AUA 2018: Active Surveillance of T1a Renal Masses: Results from National Cancer Database
San Francisco, CA USA (UroToday.com) Dave Jiang, MD, currently a second year resident at Oregon Health and Science University, presented data comparing results on the active surveillance (AS) and other intervention of T1a renal masses based on the National Cancer Database (NCDB). He focused on determining the contemporary use and results of AS in SRMs in the United States. He introduced T1a kidney cancer as a small renal mass (SRMs, ≤ 4 cm) in which 20% are benign. Active surveillance (AS) has been a management strategy since 2010 because such tumors have a low rate of metastases in the first 3 years (<5%).
AUA 2018: State-of-the-Art Lecture - Disparities in Urology: Renal Transplant
San Francisco, CA USA (UroToday.com) Charles S. Modlin, MD, from the Cleveland Clinic provided a video presentation on the disparities of renal transplants, focusing on the African American (AA) population group. He indicated that the incidence of end-stage renal disease is 4 times higher in AAs compared to European Americans (EU). The causes behind kidney failure are primarily due to hypertension and diabetes. The AA group has worse renal transplant outcomes compared to EAs and the causes for this disparity tends to be multifactorial.
AUA 2018: Crossfire: Controversies in Urology: Kidney Cancer
San Francisco, CA USA (UroToday.com) Ralph V. Clayman, MD opened the debate by proposing the use of thermal ablation in the case of a 62 year-old healthy man with a 3 cm posterolateral renal mass. This is of relevance as the rising use of computed tomography has lead to the increased discovery of renal masses of 3 cm of less.
First up in the debate was Dr. Jaime Landman, who argued for the “Pro” side of thermal ablation. Dr. Landman began by showing data on the sensitivity, specificity, and complication rates for renal, breast, lung, pancreas, thyroid, liver, and prostate biopsies. He argued that renal biopsies have a more favorable sensitivity, specificity, and complications profile than most other biopsies. Furthermore, Dr. Landman emphasized how 70% of renal masses biopsies reveal benign disease, not requiring surgical intervention.
AUA 2018: Tips and Tricks: Dissection of the Renal Mass with Hilar Fat Invasion
San Francisco, CA USA (UroToday.com) Monish Aron, MD, presented on the “enucleo-resection” of pT3a renal masses. Dr. Aron explained that pT3a renal masses are difficult to predict on pre-operative imaging and have the potential to lead to tumor violation and/or positive surgical margins with subsequent implications for prognosis.
AUA 2018: How Surgical Factors Influence Renal Functional Preservation in Healthy and "At-Risk" Kidneys after Partial Nephrectomy
San Francisco, CA USA (UroToday.com) Dr. Dagenais of the Cleveland Clinic presented a moderated poster of their study looking at the incidence and predictors of chronic kidney disease (CKD) upstaging after partial nephrectomy.
The authors retrospectively reviewed the charts of 778 patients from their single institutional database of patients who underwent partial nephrectomy. Of these patients, 634 had healthy, normal kidneys and 144 either had CKD or were at risk for developing CKD. “At risk” was defined as those patients with hypertension, diabetes, and/or a smoking history. Upstaging of CKD was determined using the estimated glomerular filtration rate (eGFR) calculated using the MDRD equation and postoperative creatinine values between 3 to 12 months.
AUA 2018: Holmium Laser Lithotripsy for Ureteral and Renal Stones: Is Dusting Equivalent to Fragmenting?
San Francisco, CA USA (UroToday.com) Dr. Thomas Knoll, from University of Tuebingen, presented research comparing two commonly used holmium laser lithotripsy settings for ureteroscopic stone treatment. The variables of frequency, energy, pulse length and shape impact the laser’s effect on the stone and therefore the outcomes of dusting and fragmentation. As ureteroscopy has become the primary treatment of choice for upper tract stones, this prospective study of 177 patients aimed to determine the optimum laser settings to improve stone management.
AUA 2018: 3-Dimensional, Virtual Reality Planning for Robotic Partial Nephrectomy
San Francisco, CA USA (UroToday.com) Dr. Joseph Shirk from UCLA Medical Center presented data on using 3-dimensional, virtual reality models of patient-specific anatomy to plan for patients undergoing robotic partial nephrectomy. He foremost introduced that surgeons have mainly been using 2-dimensional CT or MRI images for the initial planning of complex surgeries such as the robotic partial nephrectomy. Contarily, he also found that previous optical and neuroscience research associated accuracy of memory with the encounter of 3-dimensional objects.