INTRODUCTION:We aimed to report the oncological outcomes of ESRD patients with histories of urological malignancies who were subsequently submitted to kidney transplantation (KT).MATERIAL AND METHOD:Retrospective study lead in the Puigvert Foundation (Barcelona) registry of 1,200 KT performed from 1988 to 2018. Eighty-five urological malignancies that were treated before KT in 81 patients were identified: 15 (18%) prostate cancers, 49 (58%) RCC, 19 (22%) urothelial carcinomas and 2 (2%) testicular cancers. Baseline characteristics, cancer staging, treatment and follow-up were registered as well as the chronology of the start of dialysis, inscription on the waiting list and kidney transplantation. Endpoints included were cancer recurrence, metastatic progression, cancer-specific death and overall survival.RESULTS:In a median follow-up of 13.1 years (2.2-32), 16/85 (19%) cancer recurrences were reported, with 3 (4%) who progressed to metastasis and died of cancer. Median overall survival after cancer treatment was 25.3 years and cancer-specific survival was 95% at 25 years. Median time from cancer treatment to kidney transplantation was 4.8 years: 3.7 years in prostate cancer, 3.9 years in RCC and 8.8 years in bladder cancer. The median time from start of dialysis to kidney transplantation was 1.8 years in patients with histories of urological malignancy versus 0.5 year in the total cohort of 1,200 renal transplanted over the same period.CONCLUSIONS:Well-selected patients with histories of urological malignancies greatly benefit from kidney transplantation with infrequent and late cancer recurrence. Waiting time could be optimized in low-risk prostate cancer and RCC, but more robust data are needed.

Objective. - To evaluate the long-term oncological and functional results of the ablative treatment of T1a kidney malignancies by percutaneous radio-frequency (RF). Materials and methods. - Monocentric retrospective study including all patients treated for renal cell carcinoma (RCC) T1a by radiofrequency, in our center, from 2005 to 2009. All patients had a tumor biopsy before treatment. The primary endpoint was local recurrence. A total of 44 RCCs in 41 consecutive patients were treated (1 patient had 3 synchronous tumors and 1 patient had 2 tumors). There were 26 clear cell RCCs, 13 papillary RCCs and 5 chromophobe RCCs. The median age at diagnosis was 70 years [48-82]. The median American Society of Anesthesiologists (ASA) score was 2 [1-3] and the median glomerular filtration rate (GFR) was 64 mL/min [26-109]. Furhman grade was defined for 39 tumors (Clear cell RCC and papillary RCC), of which 82% were grade 1-2. The median tumor size was 20 mm [11-40], and the median RENAL score was 4 [4-6]. Complications were assessed according to the Clavien-Dindo classification. Overall survival, recurrence-free survival and metastasis-free survival were calculated using the Kaplan-Meier method. Results. - Median follow-up was 90.5 months [17.8-145.3]. Three (7%) local recurrences were reported within a median of 26 months [12-93]. All were treated by a 2nd RF. The overall 10-year survival was 70% (95% CI [56-85]). The 10-year recurrence-free survival was 72% (95% CI [57-88]). The 10-year metastasis-free survival was 87% (95% CI [74-97]). The median GFR on the date of the last news was 51 mL/min [16-98] (P = 0.05). Post-RFA complications consisted in 5 (11.3%) Clavien-Dindo 1-2 complications. No high grade (Clavien >= 3). Conclusion. - Percutaneous radiofrequency for RCC T1a is an alternative. It appears to be safe with low morbidity, satisfaying long-term oncological and functional results, but a risk of reprocessing of 7%. (C) 2020 Elsevier Masson SAS. All rights reserved.

La RTUV-HEXVIX a été associée à une augmentation du taux de détection des TVNIM par rapport à la lumière blanche et à une diminution significative du risque de récidive. L’objectif était d’évaluer la pertinence d’une RTUV-Hexvix de clôture après BCG en induction pour TVNIM de haut risque. Étude rétrospective monocentrique incluant tous les patients avec TVNIM à haut risque (T1, haut grade et/ou CIS) traités par BCG en induction de 2017 à 2020. Tous les patients ont eu une première résection avec Hexvix ± second look, un traitement par BCG en induction (6 instillations) suivie d’une cystoscopie dans les 8 semaines suivant la dernière instillation de BCG. La cystoscopie post-BCG était effectuée au bloc opératoire, en lumière blanche puis en lumière bleue, avec biopsie/résection dans le même temps de toute lésion suspecte ou fixant l’Hexvix. Le critère de jugement principal était le taux de détection de tumeur urothéliale à la cystoscopie post-BCG. 136 procédures ont été inclus : hommes 82 %, âge médian 73 ans [66-78]. Les caractéristiques tumorales à la RTUV-Hexvix initiale étaient : T1 35,6 %, haut grade 92,6 %, CIS associé 48,6 % et taille > 3 cm 26,4 %. La cystoscopie Hexvix de réévaluation était réalisée dans un délai moyen de 49 ± 13 jours après la dernière instillation. Le taux de RTUV-Hexvix positive après BCG était de 24 % (33/136 procédures) : 77 %Ta, 23 %T1, 56 %CIS associé, 68 %haut grade et 6 %TVIM. La sensibilité et spécificité de la lumière blanche et bleue étaient respectivement de 41vs91 % (p < 0,001) et 86 %vs75 % (p = 0,001). La lumière bleue a détecté 16 tumeurs supplémentaires par rapport une RTUV en lumière blanche, et a indiqué un changement de prise en charge par HIVEC™ pour 11 patients, re-BCG pour 4 patients (Ta bas grade) et 1 cystectomie. L’utilisation systématique précoce de la lumière bleue après l’induction du BCG a augmenté la détection des tumeurs réfractaires au BCG et conduit à une modification significative du traitement des TVNIM à haut risque. Des études futures sont nécessaires pour évaluer le bénéfice oncologique à long terme de la réévaluation précoce par lumière bleue et son rapport coût-efficacité.

To evaluate the long-term oncological and functional results of the ablative treatment of T1a kidney malignancies by percutaneous radiofrequency (RF).Monocentric retrospective study including all patients treated for renal cell carcinoma (RCC) T1a by radiofrequency, in our center, from 2005 to 2009. All patients had a tumor biopsy before treatment. The primary endpoint was local recurrence. A total of 44 RCCs in 41 consecutive patients were treated (1 patient had 3 synchronous tumors and 1 patient had 2 tumors). There were 26 clear cell RCCs, 13 papillary RCCs and 5 chromophobe RCCs. The median age at diagnosis was 70 years [48-82]. The median American Society of Anesthesiologists (ASA) score was 2 [1-3] and the median glomerular filtration rate (GFR) was 64mL/min [26-109]. Furhman grade was defined for 39 tumors (Clear cell RCC and papillary RCC), of which 82% were grade 1-2. The median tumor size was 20mm [11-40], and the median RENAL score was 4 [4-6]. Complications were assessed according to the Clavien-Dindo classification. Overall survival, recurrence-free survival and metastasis-free survival were calculated using the Kaplan-Meier method.Median follow-up was 90.5 months [17.8-145.3]. Three (7%) local recurrences were reported within a median of 26 months [12-93]. All were treated by a 2nd RF. The overall 10-year survival was 70% (95% CI [56-85]). The 10-year recurrence-free survival was 72% (95% CI [57-88]). The 10-year metastasis-free survival was 87% (95% CI [74-97]). The median GFR on the date of the last news was 51mL/min [16-98] (P=0.05). Post-RFA complications consisted in 5 (11.3%) Clavien-Dindo 1-2 complications. No high grade (Clavien ≥3).Percutaneous radiofrequency for RCC T1a is an alternative. It appears to be safe with low morbidity, satisfaying long-term oncological and functional results, but a risk of reprocessing of 7%.3.

OBJECTIVES To compare the detection rate of BCG refractory tumors between white light cystoscopy (WL-C) and Photodynamic Diagnosis cystoscopy (PDD-C). METHODS We performed a monocentric retrospective study that included all consecutive patients with high-risk non-muscle-invasive bladder cancer (NMIBC) diagnosed from January 2017 to January 2021. All patients had an initial Transurethral resection of bladder tumor (TURBT) with PDD ± restaging TURBT if needed, followed by full-dose BCG induction. Within 8 weeks following BCG induction all patients had both WL-C and PDD-C under general anesthesia ± TURBT in case of suspicious lesion. The primary endpoint was the detection of bladder cancer (BC) at post-BCG cystoscopy. RESULTS A total of 136 consecutive patients met inclusion criteria. Initial BC characteristics were: 35.6% of T1 tumor, 92.6% high-grade and 48.6% associated cis. BC was diagnosed in 33/136 cases (24%) at early PDD-C after BCG induction: 77% Ta, 23% T1, 56% associated cis, 68% high grade and 6% MIBC. Sensibility and Specificity of WL-C and PDD-C: 41 vs 91% (p<0.001) and 86 vs 75% (p=0.001). PDD-C detected 16 additional tumors: 81.3% Ta, 18.7% T1, 75% associated cis and 75% high grade. CONCLUSIONS Systematic use of PDD after BCG induction increased the detection of BCG-refractory tumors and lead to significant modification in the treatment of high-risk NMIBC. Future studies are needed to evaluate long-term oncological benefit of early PDD reevaluation and its cost-effectiveness.

La RTUV-HEXVIX a démontré qu’elle augmentait le taux de détection des TVNIM par rapport à la lumière blanche et une diminution significative du risque de récidive. L’objectif était d’évaluer la pertinence d’une RTUV-Hexvix de clôture après BCG en induction pour TVNIM de haut risque. Étude rétrospective monocentrique incluant tous les patients avec TVNIM à haut risque traités par BCG en induction de 2017 à 2020. Tous les patients ont eu une première résection avec Hexvix confirmant une TVNIM haut risque, un traitement par BCG en induction (6 instillations) suivie d’une cystoscopie Hexvix dans les 6 semaines suivant la dernière instillation de BCG. Les patients avec TVNIM de risque faible, intermédiaire, qui n’ont pas eu de luminofluorescence et/ou qui n’ont pas reçu 6 instillations de BCG, ont été exclus. Le critère de jugement principal était le taux de tumeur urothéliale prouvée histologiquement à la cystoscopie Hexvix post-BCG. Cent seize procédures (RTUV-Hexvix-BCG induction-cystoscopie Hexvix) chez 102 patients ont été incluses : sexe masculin 82 %, âge médian 73 ans [30–93]. Les caractéristiques tumorales à la RTUV-Hexvix initiale étaient : Ta 67 %, T1 33 %, haut grade 93 %, CIS associé 46 %, taille < 3 cm 88 % et 29 % ont eu un « second look ». La cystoscopie Hexvix de ré-évaluation post-BCG était effectuée dans un délai moyen de 49 ± 13 jours après la dernière instillation de BCG. Le taux de RTUV-Hexvix positive après BCG était de 22 % (26/114 procédures) : 73 % Ta, 27 % T1, 58 % CIS associé, 73 % haut grade. Les sensibilités de la lumière blanche et bleue pour la détection précoce de TVNIM post-BCG étaient respectivement : 42 vs 92 % (p = 0,001) et les spécificités de 83 % vs 71 % (p = 0,006). La lumière bleue a détecté 14/26 patients supplémentaires par rapport une RTUV en lumière blanche, et a indiqué un changement de prise en charge avec une nouvelle induction de BCG pour 13 patients et 1 traitement radical (cystectomie). La réalisation d’une RTUV-Hexvix précoce a permis d’augmenter significativement le taux de détection de tumeur urothéliale après induction de BCG pour TVNIM haut risque, et d’indiquer une prise en charge autre qu’une surveillance, avec cependant un taux de faux positifs élevé (VPP = 48 %).

You have accessJournal of UrologyTransplantation & Vascular Surgery: Renal Transplantation & Vascular Surgery III (MP76)1 Apr 2019MP76-14 PROSPECTIVE COMPARATIVE STUDY ON ROBOT-ASSISTED VS OPEN KIDNEY TRANSPLANTATION: TREND TO LESS PERIOPERATIVE INFLAMMATORY RESPONSE AND SIMILAR FUNCTIONAL RESULTS Angelo Territo*, Jose Daniel Subiela, Gerit Theil, Lluis Gausa, Giuseppe Basile, Federica Regis, Romain Boissier, Mohammed Nasreldin, Andrea Gallioli, Paolo Fornara, Lluis Guirado, and Alberto Breda Angelo Territo*Angelo Territo* More articles by this author , Jose Daniel SubielaJose Daniel Subiela More articles by this author , Gerit TheilGerit Theil More articles by this author , Lluis GausaLluis Gausa More articles by this author , Giuseppe BasileGiuseppe Basile More articles by this author , Federica RegisFederica Regis More articles by this author , Romain BoissierRomain Boissier More articles by this author , Mohammed NasreldinMohammed Nasreldin More articles by this author , Andrea GallioliAndrea Gallioli More articles by this author , Paolo FornaraPaolo Fornara More articles by this author , Lluis GuiradoLluis Guirado More articles by this author , and Alberto BredaAlberto Breda More articles by this author View All Author Informationhttps://doi.org/10.1097/01.JU.0000557306.85692.33AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVES: Open kidney transplantation (OKT) is the preferred approach in kidney transplantation (KT), but robot-assisted kidney transplantation (RAKT) has been recently standardized. The main aim of this study is to prospectively quantify the inflammatory response and the functional results of OKT vs RAKT. METHODS: We prospectively compared the inflammatory response between standard OKT and RAKT. 30 patients underwent pre-emptive KT between January and December 2017 (15 RAKT, 15 OKT). Blood levels of inflammatory markers (NGAL, CRP, IL-6) were measured at several time points: T0 (preoperative/baseline), T1(H1), T2(H6), T3(H12), T4(H24), T5(D2), T6(D3) and T7(D5) after KT. Serum creatinine and estimated glomerular filtration rate (eGFR) were evaluated at postoperative days 1, 3 and 7. A point-to-point analysis was performed, the differences in clinical variables between RAKT and OKT were evaluated using the unpaired t-test or non parametric Mann Whitney U test. RESULTS: IL-6 and CRP significantly increased in both groups after surgery compared with baseline (×—9 and ×—15 respectively, all p<0.01). There was a significant difference in the mean level of IL-6 at T1 (H1) and T3(H12) in the advantage of RAKT (p<0.01). Significant differences in the mean level of CPR were found at T3(H12) and T5(D2) in the advantage of RAKT (p<0.01). Compared to baseline NGAL significantly decreased in both RAKT (p<0.01) and OKT (p<0.01). Significant differences in the mean level of NGAL were found at T3(H12), T4(H24) and T6(D3) in the advantage of RAKT. Serum creatinine and eGFR at postoperative days 1, 3 and 7 were similar in RAKT and OKT (all p>0.05). CONCLUSIONS: RAKT trended to induce a lower inflammatory response compared with OKT. Short term functional outcomes and complications rate were similar in RAKT vs OKT. Source of Funding: The project has been supported by the Eureopean association of Urology (EAU). The EAU Section of Transplantation Urology (ESTU) has sponsored a grant. Barcelona, Spain; Halle, Germany; Barcelona, Spain; Marseille, France; Halle, Germany; Barcelona, Spain; Halle, Germany; Barcelona, Spain© 2019 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 201Issue Supplement 4April 2019Page: e1128-e1128 Advertisement Copyright & Permissions© 2019 by American Urological Association Education and Research, Inc.MetricsAuthor Information Angelo Territo* More articles by this author Jose Daniel Subiela More articles by this author Gerit Theil More articles by this author Lluis Gausa More articles by this author Giuseppe Basile More articles by this author Federica Regis More articles by this author Romain Boissier More articles by this author Mohammed Nasreldin More articles by this author Andrea Gallioli More articles by this author Paolo Fornara More articles by this author Lluis Guirado More articles by this author Alberto Breda More articles by this author Expand All Advertisement PDF downloadLoading ...

IntroducciónComparar los resultados oncológicos, funcionales y postoperatorios de la crioablación hemiglandular (CH) vs. crioablación de toda la glándula (CT) como terapia primaria del cáncer de próstata localizado.Material y métodoSe incluyeron 66 pacientes consecutivos tratados entre 2010 y 2018 con crioablación total (CT=40) o crioablación hemiglandular (CH=26) en un centro de referencia terciario. Todos los pacientes tenían cáncer de próstata de riesgo bajo-intermedio según criterios D’Amico. Se propuso crioablación hemiglandular en caso de cáncer de próstata unilateral comprobado por biopsia y RM. La variable principal de evaluación fue el fracaso de la crioterapia, para el que se consideraron y compararon tres definiciones: 1) fallo bioquímico (> PSA nadir+≥ 2 ng/mL), 2) rebiopsia positiva de próstata Gleason ≥ 7, y 3) inicio de un tratamiento adicional para el cáncer de próstata.ResultadosLa edad media de los pacientes durante el tratamiento fue 74 [42-81] vs. 76 [71-80] años en el grupo de CT vs. CH, respectivamente (p=0,08). Los grupos de riesgo bajo e intermedio (D’Amico) fueron 15% y 85% frente a 23% y 77% (p=0,75), respectivamente. El tiempo medio de seguimiento fue de 41 [1,5-99,0] vs. 27 [0,9-93] meses (p=0,03). La supervivencia libre de fracaso de la crioterapia a cuatro años en CT vs. CH fue de 69% vs. 53% con la definición 1 (p=0,24), 82% vs. 80% con la definición 2 (p=0,95), y 83% vs. 77% con la definición 3 (p=0,73).La continencia urinaria postoperatoria y al año fue de 60% y 83% en CT frente a 72% y 83% en CH (p=0,26). La impotencia de novo tras la crioterapia fue del 75% frente al 46% (p=0,33) en CT y CH, respectivamente.ConclusionesEn nuestra cohorte de pacientes altamente seleccionados con CP unilateral de riesgo bajo-intermedio, la crioterapia hemiglandular puede proporcionar resultados oncológicos similares y menos complicaciones tempranas en comparación con la crioablación de toda la glándula.

Introduction: To compare oncological, functional and post-operative outcomes of hemi (HC) vs. whole gland (WGC) cryoablation as first line treatment of localized prostate cancer. Material and method: Sixty-six consecutive patients undertaking whole-gland cryoablation (WGC = 40) or hemi-cryoablation (HC = 26) in a tertiary referral centre between 2010 and 2018 were included. All patients had a low-intermediate risk prostate cancer according to D'Amico risk classification. Hemi-ablation was proposed in case of biopsy and prostate MRI proven unilateral prostate cancer. Primary endpoint was Cryotherapy Failure for which 3 definitions were considered and compared: 1) biochemical failure (> PSA nadir + >= 2 ng/mL), 2) positive prostate re-biopsy with Gleason score >= 7, 3) initiation of further prostate cancer treatment. Results: Median patients age at treatment was 74 [42-81] vs. 76 [71-80] years in WGC vs. HC group, respectively (p = .08). Low and intermediate D'Amico risk group were 15% and 85% vs. 23% and 77% (p = .75), respectively. Median follow- up time was 41 [1.5-99.0] vs. 27 [0.9-93] months (p = .03). Four-years cryotherapy failure free survival in WGC vs. HC were 69% vs. 53% with definition 1 (p = .24), 82% vs. 80% with definition 2 (p = .95), 83% vs. 77% with definition 3 (p = .73). Early and 1-year urinary continence were 60% and 83% in WGC vs. 72% and 83% in HC (p = .26). De novo impotency after cryotherapy was 75% vs. 46% (p = .33) in WGC vs. HC. Conclusions: In our cohort of highly selected patients with unilateral low/intermediate risk PCa, hemi-cryoablation may provide similar oncological outcomes and less early complications compared to whole-gland cryoablation. (C) 2019 AEU. Published by Elsevier Espana, S.L.U. All rights reserved.