micro-ultrasound-guided-transperineal-prostate-biopsy-clinic-based

Micro-Ultrasound Guided Transperineal Prostate Biopsy: A Clinic-Based Procedure

Prostate cancer is the most common solid malignancy in men and requires a biopsy for diagnosis. This manuscript describes a freehand micro-ultrasound ...

University of Florida College of Medicine

Because the majority of small renal masses (SRMs; <4 cm) demonstrate low metastatic potential and can be effectively treated with radical or partial nephrectomy, the role of lymph node dissection (LND) at the time of surgery is unclear. A randomized trial demonstrated no survival benefit of LND in clinically localized renal cell carcinoma. Thus, LND is not recommended routinely for SRMs. For patients with high-risk features or radiographic evidence of lymphadenopathy, however, LND may improve local staging and potentially provide a survival benefit. If performed, a LND template should be based on the known lymphatic drainage of the kidneys.

Lymph Node Dissection for Small Renal Masses.

Although surgical excision is the standard of therapy for small renal masses (SRMs), there is a growing recognition of active surveillance as an option in select patients who are poor surgical candidates or who have shorter life expectancy. A number of patients on expectant management, however, subsequently advance to definitive therapy. In this study, we systematically reviewed the literature and performed a pooled analysis of active surveillance series to evaluate the rate and indications for definitive treatment after initiating a period of active surveillance. Fourteen clinical series (1245 patients; 1364 lesions) met our selection criteria. Mean lesion size at presentation was 2.30 ± 0.40 cm with a mean follow-up of 33.6 ± 16.9 months. Collectively, 34.0% of patients underwent delayed intervention, which ranged in individual series from 3.6% to 70.3%. Of patients undergoing delayed intervention, the average time on active surveillance prior to definitive treatment was 27.8 ± 10.6 months. A pooled analysis revealed that 41.0% of patients underwent therapy secondary to tumor growth rate and 51.9% secondary to patient or physician preference in the absence of clinical progression. Overall, 1.1% of all patients progressed to metastatic disease during the average follow-up period. Thus, active surveillance may be an appropriate option for carefully selected patients with SRMs. However, delayed treatment is pursued in a significant percentage of patients within 3 years. Prospective registries and clinical trials with standardized indications for delayed intervention are needed to establish true rates of disease progressions and recommendations for delayed intervention.

Delayed Intervention of Small Renal Masses on Active Surveillance.

Results of randomized trials support a single dose of intravesical chemotherapy following radical nephroureterectomy (RNU) for urothelial carcinoma.

Evaluation of Intraoperative Versus Postoperative Adjuvant Mitomycin C with Nephroureterectomy for Urothelial Carcinoma of the Upper Urinary Tract.

To evaluate the ability of Aorta-Lesion-Attenuation Difference (ALAD) to differentiate malignant renal tumors from renal oncocytomas.

Using Aorta-Lesion-Attenuation Difference on Preoperative Contrast-enhanced Computed Tomography Scan to Differentiate Between Malignant and Benign Renal Tumors.

Increased acute postoperative pain intensity has been associated with the development of persistent postsurgical pain (PPP) in mechanistic and clinical investigations, but it remains unclear which aspects of acute pain explain this linkage.

Predicting long-term postsurgical pain by examining the evolution of acute pain.

The primary goal of this study was to evaluate patterns in acute postoperative pain in a mixed surgical patient cohort with the hypothesis that there would be heterogeneity in these patterns.

Patient and Procedural Determinants of Postoperative Pain Trajectories.

Evidence suggests that increased early postoperative pain (POP) intensities are associated with increased pain in the weeks following surgery. However, it remains unclear which temporal aspects of this early POP relate to later pain experience. In this prospective cohort study, we used wavelet analysis of clinically captured POP intensity data on postoperative days 1 and 2 to characterize slow/fast dynamics of POP intensities and predict pain outcomes on postoperative day 30.

Slow Dynamics of Acute Postoperative Pain Intensity Time Series Determined via Wavelet Analysis Are Associated With the Risk of Severe Postoperative Day 30 Pain.

We previously noted that the aorta-lesion-attenuation difference (ALAD) determined on CT scan discriminated well between chromophobe RCC and oncocytoma. The current evaluation seeks to validate these initial findings in a second cohort of nephrectomy patients.

Validation of aorta-lesion-attenuation difference on preoperative contrast-enhanced computed tomography scan to differentiate between malignant and benign oncocytic renal tumors.

Several features noted on renal mass biopsy (RMB) can influence treatment selection including tumor histology and nuclear grade. However, there is poor concordance between renal cell carcinoma (RCC) nuclear grade on RMB compared to nephrectomy specimens. Here, we evaluate the association of nuclear grade with aorta-lesion-attenuation-difference (ALAD) values determined on preoperative CT scan.

Association between nuclear grade of renal cell carcinoma and the aorta-lesion-attenuation-difference.

Acute postoperative pain intensity is associated with persistent postsurgical pain (PPP) risk. However, it remains unclear whether acute postoperative pain intensity mediates the relationship between clinical factors and persistent pain.

Effects of Patient and Surgery Characteristics on Persistent Postoperative Pain: A Mediation Analysis.

Succinate dehydrogenase (SDH) deficient renal cell carcinoma (RCC) are uncommon renal tumors that typically present in relatively younger patients. SDH mutations are known to cause cancer, but often presents with hereditary paragangliomas, pheochromocytomas, and gastrointestinal stromal tumors. This report details a case of SDH deficient RCC in a patient with no know contributing family history. Patient presented with recurrent urinary tract infections and groin pain. Computerized tomography (CT) revealed a 4 cm mass in the right kidney. Partial nephrectomy was performed, and the patient had an uneventful recovery. Immunohistochemical staining revealed the tumor was SDH negative.

Article	Year
Lymph Node Dissection for Small Renal Masses. The Urologic clinics of North America\| PubMed ID: 28411918	2017
Delayed Intervention of Small Renal Masses on Active Surveillance. Journal of kidney cancer and VHL\| PubMed ID: 28725541	2017
Evaluation of Intraoperative Versus Postoperative Adjuvant Mitomycin C with Nephroureterectomy for Urothelial Carcinoma of the Upper Urinary Tract. Bladder cancer (Amsterdam, Netherlands)\| PubMed ID: 30417049	2018
Using Aorta-Lesion-Attenuation Difference on Preoperative Contrast-enhanced Computed Tomography Scan to Differentiate Between Malignant and Benign Renal Tumors. Urology\| PubMed ID: 30552939	2019
Predicting long-term postsurgical pain by examining the evolution of acute pain. European journal of pain (London, England)\| PubMed ID: 33171546	2021
Patient and Procedural Determinants of Postoperative Pain Trajectories. Anesthesiology\| PubMed ID: 33449996	2021
Slow Dynamics of Acute Postoperative Pain Intensity Time Series Determined via Wavelet Analysis Are Associated With the Risk of Severe Postoperative Day 30 Pain. Anesthesia and analgesia\| PubMed ID: 33591118	2021
Validation of aorta-lesion-attenuation difference on preoperative contrast-enhanced computed tomography scan to differentiate between malignant and benign oncocytic renal tumors. Abdominal radiology (New York)\| PubMed ID: 33665734	2021
Association between nuclear grade of renal cell carcinoma and the aorta-lesion-attenuation-difference. Abdominal radiology (New York)\| PubMed ID: 34463815	2021
Effects of Patient and Surgery Characteristics on Persistent Postoperative Pain: A Mediation Analysis. The Clinical journal of pain\| PubMed ID: 34475340	2021
Succinate dehydrogenase deficient renal cell carcinoma: A case report. Urology case reports\| PubMed ID: 34712582	2022

Paul Crispen

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