PURPOSE:The Alberta Prostate Cancer Research Initiative (APCaRI) Registry and Biorepository was established in 2014 by the APCaRI to facilitate the collection of clinical and patient-reported data, biospecimen, to measure prostate cancer outcomes and to support the development and clinical translation of innovative technologies to better diagnose and predict outcomes for patients with prostate cancer. PARTICIPANTS:Men suspected with prostate cancer and referred to Urology centres in Alberta were enrolled in the APCaRI 01 study, while men with a prior prostate cancer diagnosis participated in the APCaRI 03 study from 1 July 2014 to 30 June 2019. The APCaRI Registry and Biorepository links biospecimens and data from a wide representation of patients drawn from an Alberta population of more than 4 million. FINDINGS TO DATE:From 1 July 2014 to 30 June 2019, total APCaRI 01 and 03 study recruitment was 3754 men; 142 (4%) of these men withdrew in full, 65 men (2%) withdrew biospecimens and 123 men (3%) died of any cause. Over this same time, 8677 patient-reported outcome measure (PROM) surveys and 7368 biospecimens were collected and are available from the registry and biorepository, respectively. The data entry error rate was 0.8% and 0.95% for critical and non-critical values, respectively, and 1.8% for patient-reported surveys. FUTURE PLANS:The APCaRI Registry and Biorepository will collect longitudinal data and PROM surveys until 2024, patient outcomes up to 25 years after recruitment and biospecimen storage for up to 25 years. The APCaRI cohorts will continue to provide data and samples to researchers conducting retrospective studies. The richness of the data and biospecimens will complement many different research questions, ultimately to improve the quality of care for men with prostate cancer.

Cryosurgical destruction of primary adenocarcinoma of the prostate was performed via perineal route in 215 patients during a 12-year period. The average age of the patients was 66 years. The stage of the disease varied from stage B to D. In 74% of the patients, no clinical evidence of tumor was found in the prostatic fossa following cryosurgery. Few patients needed transurethral surgery and none needed repeated transurethral resections for obstructive symptoms. This experience suggests that local destruction of prostatic carcinoma can be achieved with little morbidity and mortality. Herein wer discuss the method of cryosurgery, stage and histology or tumor, survival, local recurrence, and complications.

INTRODUCTION:Anastomotic pseudoaneurysm is one of the rarest vascular complications after renal transplant surgery. Therapeutic options include open surgical repair or endovascular stenting.CASE PRESENTATION:Case 1 had pseudoaneurysm involving external iliac artery and was managed by jump graft to allograft using cadaveric donor iliac arteries and patch angioplasty repair of external iliac artery after excising pseudoaneurysm. Case 2 had undergone orthotopic renal transplant with spleno-renal arterial anastomosis and developed a massive pseudoaneurysm proximal to spleno-renal arterial anastomosis. This patient underwent endovascular stenting preserving allograft vascularity and graft function. Outcome in both patients was successful with normalization of renal function to baseline levels.CONCLUSION:Treatment of renal transplant anastomotic pseudoaneurysms is difficult and associated with high rates of graft loss. Open surgery is the gold standard providing several possibilities for arterial reconstruction preserving graft and limb circulation. Endovascular treatment should be considered in high-risk surgical patients with favorable anatomy.

The role of the calcium channel blocker (verapamil) in kidney transplant is controversial. Verapamil has been hypothesized to mitigate ischemia reperfusion injury (IRI) to the allograft. Herein, we evaluated the effect of intra-operative verapamil administration in a large cohort of kidney transplants. Total 684 transplants were performed during 2007-2017. Of these, 348 (50.9%) transplants received verapamil (2.5 mg) Ver (+), and 336 (49.1%) did not, Ver (-). Based on the donor type, the study was divided into three groups; living donor (LD) (N = 270), neurological determination of death (NDD) (N = 394), and donation after cardiac death (DCD) (N = 20). Ver (-) subgroup had more diabetic recipients as compared to Ver (+) subgroup in LD and NDD groups (P < 0.05). No significant difference was found for delayed graft function in any of the group (P > 0.05). Cold ischemia time and dialysis requirement were significantly higher in Ver (+) LD and NDD groups, respectively. Except for DCD group, there was no significant difference in eGFR (mL/min) immediately and 6 months after kidney transplant in any of the groups. Furthermore, univariate and multivariate logistic regression analysis was performed to account for potential confounders, but verapamil administration did not improve graft function in any of the groups (P > 0.05) after transplant.

Introduction: Salvage cryotherapy is a guideline-recommended treatment of localized prostate cancer recurrence after radiation therapy. There is little published evidence analyzing the outcomes of salvage cryotherapy for recurrent prostate cancer following different primary therapy energy modalities. Methods: We performed a retrospective analysis of patients who received whole gland salvage cryotherapy from 2007–2017 at a large tertiary referral center after either primary radiation therapy (RT) or primary whole gland cryotherapy. Primary outcome was biochemical failure, defined as per the Phoenix criteria (prostate-specific antigen [PSA] nadir + 2.0 ng/ml). Secondary outcomes included time to biochemical failure and development of metastatic disease. Results: Fifty-eight out of 391 patients who received cryotherapy were identified as having received salvage cryotherapy (after RT, n=37; after primary cryotherapy, n=21). Biochemical recurrence occurred in 21 (57%) patients with previous RT and in 17 (81%) patients with previous cryotherapy (p=0.001). Median time to biochemical recurrence was 18 months for patients with previous RT and 13 months for patients with previous cryotherapy (p=0.002). The biochemical free survival rate for primary radiation therapy patients was 71% at two years compared to 23% at two years for patients who underwent primary cryotherapy (p<0.01). There was no difference in the development of metastatic disease between groups (19% vs. 18%, cryo vs. radiation, p=0.34). Conclusions: These results suggest that salvage cryotherapy may offer more durable oncological control to patients after radiation compared to primary cryotherapy with a lower rate and longer duration before biochemical recurrence.

INTRODUCTION Salvage cryotherapy is a guideline-recommended treatment of localized prostate cancer recurrence after radiation therapy. There is little published evidence analyzing the outcomes of salvage cryotherapy for recurrent prostate cancer following different primary therapy energy modalities. METHODS We performed a retrospective analysis of patients who received whole gland salvage cryotherapy from 2007-2017 at a large tertiary referral center after either primary radiation therapy (RT) or primary whole gland cryotherapy. Primary outcome was biochemical failure, defined as per the Phoenix criteria (prostate-specific antigen [PSA] nadir + 2.0 ng/ml). Secondary outcomes included time to biochemical failure and development of metastatic disease. RESULTS Fifty-eight out of 391 patients who received cryotherapy were identified as having received salvage cryotherapy (after RT, n=37; after primary cryotherapy, n=21). Biochemical recurrence occurred in 21 (57%) patients with previous RT and in 17 (81%) patients with previous cryotherapy (p=0.001). Median time to biochemical recurrence was 18 months for patients with previous RT and 13 months for patients with previous cryotherapy (p=0.002). The biochemical free survival rate for primary radiation therapy patients was 71% at two years compared to 23% at two years for patients who underwent primary cryotherapy (p\u003c0.01). There was no difference in the development of metastatic disease between groups (19% vs. 18%, cryo vs. radiation, p=0.34). CONCLUSIONS These results suggest that salvage cryotherapy may offer more durable oncological control to patients after radiation compared to primary cryotherapy with a lower rate and longer duration before biochemical recurrence.

Pain control following major abdominal surgery remains a significant barrier to patient comfort. Although thoracic epidurals have been used to provide analgesia for these surgeries, the transversus abdominis plane (TAP) block is gaining popularity. The TAP catheter insertion method has transformed over the past two decades from a blinded technique to one conducted primarily under ultrasound guidance by anesthesiologists. Recently, however, interest has increased on the potential for direct surgical insertion of catheters into the TAP plane following flank incisions due to anatomical considerations. Proposed advantages include a reduction in operating time, requirement of minimal expertise and increased accuracy of catheter placement. In this report, we describe the rationale and the technique of surgical insertion of TAP catheters following open nephrectomies as performed by urologists at our institution.

A 26-year-old male body builder diagnosed with renal artery stenosis and middle aortic syndrome underwent an autotransplantation with bench reconstruction and end-to-end anastomosis using the hypogastric artery. Shortly after the procedure, the patient developed rhabdomyolysis and renal insufficiency, possibly related to his increased muscle mass, potentially greater susceptibility to hypertrophic skeletal muscle cells or his unique vascular condition. We review the risk factors, diagnosis, management and outcome of a case of rhabdomyolysis in a male patient who underwent autotransplantation for renal vascular hypertension.

You have accessJournal of UrologyKidney Cancer: Evaluation and Staging1 Apr 2011693 ADULT COMORBIDITY EVALUATION-27 SCORE IS AN INDEPENDENT PREDICTOR OF POSTOPERATIVE RENAL DYSFUNCTION AND OVERALL SURVIVAL Conrad Maciejewski, Sarah Moore, Brendan Diederichs, Paul Cartledge, Gerald Todd, and Ronald Moore Conrad MaciejewskiConrad Maciejewski Edmonton, Canada More articles by this author , Sarah MooreSarah Moore Edmonton, Canada More articles by this author , Brendan DiederichsBrendan Diederichs Edmonton, Canada More articles by this author , Paul CartledgePaul Cartledge Edmonton, Canada More articles by this author , Gerald ToddGerald Todd Edmonton, Canada More articles by this author , and Ronald MooreRonald Moore Edmonton, Canada More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.1660AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The Adult Comorbidity Evaluation 27 (ACE-27) is a validated comorbidity analysis questionnaire. The aim of our study was to evaluate the role of ACE-27 comorbidity score in predicting postoperative renal function outcomes as well as overall survival. METHODS The Alberta Urology Institute Nephrectomy Database is a comprehensive multicenter retrospective database encompassing all demographic, clinical, and pathologic outcomes of patients undergoing radical and partial nephrectomy for renal cell carcinoma in the last 5 years. A total of 690 patient charts have been abstracted. Preoperative demographic data was used to calculate ACE-27 comorbidity score. The Modification of Diet in Renal Disease equation was used to calculate GFR using preoperative and postoperative data within 3 months of surgery. Univariate and multivariate linear and logistic regression models were designed using age, tumor stage, GFR, surgical approach, ACE-27 score, and overall survival as covariates. RESULTS A total of 690 patients were evaluated, with a mean age of 59. Stage distribution showed 46% T1a, 17% T1b, 19% T2, 15% T3, and 2% T4. Mean preoperative GFR was 85 ± 30 ml/min. ACE-27 score distribution showed 34% scoring 0, 42% scoring 1, 16% scoring 2, and 7% scoring 3. Median follow up was 3.2 years. Univariate linear regression identified age, ACE-27 score, and surgical approach as predictors of postoperative GFR < 60 ml/min (p<0.0001). Multivariate linear regression analysis confirmed these results, with age, ACE-27 score, and surgical approach being independent predictors of postoperative GFR < 60 ml/min (p<0.0001). Survival data was available for 219 patients, with an overall 19.6% 5 year mortality. In multivariate logistic regression, age was the only statistically significant factor predicting mortality (p=0.009) with a trend for ACE-27 (p=0.08). Subgroup analysis of individual ACE-27 scores identified high comorbidity (ACE-27 = 3) to be an independent predictor of mortality (p=0.005). CONCLUSIONS Our data support the use of ACE-27 comorbidity score as a prognostic tool in clinical decision making for surgical management of renal cell carcinoma, in regards to postoperative renal function outcomes and overall survival. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e279 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information Conrad Maciejewski Edmonton, Canada More articles by this author Sarah Moore Edmonton, Canada More articles by this author Brendan Diederichs Edmonton, Canada More articles by this author Paul Cartledge Edmonton, Canada More articles by this author Gerald Todd Edmonton, Canada More articles by this author Ronald Moore Edmonton, Canada More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Background. Uncertainty remains in the prognostic utility of biopsies of deceased donor kidneys in predicting graft outcomes. Methods. We examined implantation biopsies for 730 kidney transplant recipients from 491 deceased donors from 1990 to 2004. The median follow-up time was 5.1 years. Of the 730 transplants, 633 (86.7%) had implantation biopsies (wedge 89.1%). Of these 633, 541 (85.5%) could be assessed for % glomerulosclerosis (GS), interstitial fibrosis, tubular atrophy, arteriolar hyalinosis, and fibrous intimal thickening. Independent risk factors for delayed graft function include regraft, longer cold ischemia time, and DR mismatch, but not donor age. Independent risk factors for worse function at 6 months include regraft, older donor and recipient, female donor and recipient, and rejection. Independent risk factors of graft failure include regraft, older donor age, male recipient, and rejection. Results. Of the histologic scores, arteriolar hyalinosis was independently associated with delayed graft function and graft loss, whereas fibrous intimal thickening was associated with decreased 6-month renal function. Importantly, the degree of GS was not independently associated with outcomes. Conclusions. Therefore, although biopsy evidences of vascular pathologic condition, kidney may contribute meaningfully to the assessment of donor quality but the degree of GS does not.

PURPOSE:We determined the associations between comorbidity, and overall survival and bladder cancer specific survival after radical cystectomy.MATERIALS AND METHODS:The Alberta Urology Institute Radical Cystectomy database is an ongoing multi-institutional computerized database containing data on all adult patients with a diagnosis of primary bladder cancer treated with radical cystectomy in Edmonton, Canada from April 1994 forward. The current study is an analysis of consecutive database patients treated between April 1994 and September 2007. Comorbidity information was obtained through a medical record review using the Adult Comorbidity Evaluation 27 instrument. The outcome measures were overall survival and bladder cancer specific survival. Cox proportional regression analysis was used to determine the associations between comorbidity, and overall survival and bladder cancer specific survival.RESULTS:Of the database patients 160 (34%), 225 (48%) and 83 (18%) had no/mild comorbidity, moderate comorbidity and severe comorbidity, respectively. Compared to patients with no or mild comorbidity, multivariate Cox proportional regression analyses that included age, adjuvant chemotherapy, surgeon procedure volume, pathological T stage, pathological lymph node status, total number of lymph nodes removed, surgical margin status and lymphovascular invasion showed that increased comorbidity was independently associated with overall survival (moderate HR 1.59, 95% CI 1.16-2.18, p = 0.004; severe HR 1.83, 95% CI 1.22-2.72, p = 0.003) and bladder cancer specific survival (moderate HR 1.50, 95% CI 1.04-2.15, p = 0.028; severe HR 1.65, 95% CI 1.04-2.62, p = 0.034).CONCLUSIONS:Increased comorbidity was independently associated with an increased risk of overall mortality and bladder cancer specific mortality after radical cystectomy.

PURPOSE:We determined the associations among age, comorbidity and clinical outcomes after radical cystectomy.MATERIALS AND METHODS:The study was a retrospective cohort analysis of 314 consecutive patients with primary bladder cancer treated with radical cystectomy between January 2000 and December 2006 in Edmonton, Canada. Comorbidity was obtained through a medical record review using the Adult Comorbidity Evaluation-27 instrument. The main clinical outcomes were 90-day mortality, early postoperative complications, and major and minor early postoperative complications. Logistic regression analyses were used to determine predictors of clinical outcomes.RESULTS:The 90-day mortality, any early postoperative complications, and major and minor early postoperative complications occurred in 18 (5.7%), 148 (47.1%), 78 (24.8%) and 92 (29.3%) patients, respectively. In univariate and multivariate logistic regression analysis age was not associated with 90-day mortality or early postoperative complications. In contrast, compared to patients with no or mild comorbidity, multivariate logistic regression analysis adjusted for age and surgeon procedure volume showed that severe comorbidity was associated with an increased risk of 90-day mortality (OR 6.4, p = 0.03). In addition, compared to patients with no or mild comorbidity, multivariate logistic regression analysis adjusted for age, sex, surgeon procedure volume, type of urinary tract reconstruction and American Joint Committee on Cancer stage showed that moderate and severe comorbidity were associated with any early postoperative complications (moderate OR 5.2, p <0.001; severe OR 7.0, p <0.001), major early postoperative complications (moderate OR 11.4, p <0.001; severe OR 15.2, p <0.001) and minor early postoperative complications (moderate OR 2.1, p = 0.019; severe OR 2.2, p = 0.038).CONCLUSIONS:Increasing comorbidity was independently associated with an increased risk of 90-day mortality and early postoperative complications after radical cystectomy.