Urologic oncology
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Inferior vena caval tumor thrombus (IVC-TT) occurs in 10% of patients diagnosed with renal cell carcinoma (RCC). The perioperative management of these patients remains challenging. Despite multiple publications outlining surgical approaches and outcomes there have been few studies detailing the best peri-operative management of patients with IVC-TT. Our goal was to define the optimal management of patients with RCC and IVC-TT. ⋯ This study identified the available literature on the management of IVC-TT in association with RCC and was carefully reviewed by a multidisciplinary team. As a result, we have established a set of practice guidelines at our institution to help optimally manage patients with renal cell carcinoma and an inferior venal caval thrombus.
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To define characteristics of the first cycle of intermittent androgen deprivation (IAD) that would predict for outcomes in a long term follow-up. ⋯ Cases with BP after RP selected to IAD that show at the first cycle a PSA nadir ≤ 0.1 ng/ml and a off-phase interval ≥ 48 weeks may identify candidates who will experience better response to IAD treatments and delayed CP or CRPC development.
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Renal dysfunction is common in urologic patients, especially in those undergoing nephrectomy for renal cancer. Partial nephrectomy better preserves renal function than radical nephrectomy, but is associated with acute kidney injury related to loss of nephrons and ischemic injury. ⋯ Molecular markers, such as cystatin C, neutrophil gelatinase-associated lipocalin (NGAL), IL-18 and kidney injury molecule-1 (KIM-1), better quantify the extent of acute ischemic and/or tubular injury than other currently available tools. The use of these and/or other markers may facilitate research to improve outcomes following partial nephrectomy.
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Late relapses (>2 years) after completion of chemotherapy are rare and often platinum-resistant. There are limited data concerning late relapses in chemotherapy-naïve patients with stage I germ cell tumors. This retrospective analysis was performed to compare the outcome between patients with stage I germ cell tumors, who had late (≥2 years) and early (≥3 months and <2 years) relapse after orchiectomy. ⋯ Late relapses following stage I germ cell tumors were associated with seminoma, older age, and worse outcome after induction chemotherapy.
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Randomized Controlled Trial Comparative Study
Noninfiltrative anesthesia for transrectal prostate biopsy: a randomized prospective study comparing lidocaine-prilocaine cream and lidocaine-ketorolac gel.
Periprostatic nerve block (PPNB) is the standard anesthesia for ultrasound (US) guided transrectal prostate biopsy (TPB), but periprostatic infiltration itself constitutes a major, though often neglected, source of discomfort even in patients receiving perianal-intrarectal lidocaine-prilocaine (PILP) cream before PPNB. Noninfiltrative anesthesia therefore represents an attractive alternative to periprostatic infiltration. With this in mind, we aimed to determine the efficacy and safety of perianal-intrarectal (PI) lidocaine gel, lidocaine-ketorolac gel, and lidocaine-prilocaine cream in relieving pain during TPB. ⋯ Lidocaine-prilocaine cream was most effective on probe-related pain, whereas lidocaine-ketorolac gel was most effective on sampling-related pain. These noninfiltrative anesthetics were safe, easy to administer, and well accepted by patients; the possibility to combine them to further improve pain control during TPB deserves further well-designed studies.