To evaluate outcomes of flexible ureteroscopy for renal stones by comparing hard versus soft stones based on their attenuation on computed tomography (Hounsfield Units—HU). Patients were divided into two groups according to the type of laser employed [Holmium:YAG (HL) or Thulium fiber laser (TFL)]. Residual fragments (RF) were defined as > 2 mm. Multivariable logistic regression analysis was performed to evaluate factors associated with RF and RF needing further intervention. 4208 patients from 20 centers were included. In whole series, age, recurrent stones, stone size, lower pole stones (LPS), and multiple stones were predictors of RF at multivariable analysis and LPS and stone size with RF requiring further treatment. HU and TFL were associated with lesser RF and RF requiring an additional treatment. In HU < 1000 stones, recurrent stones, stone size, and LPS were predictors of RF at multivariable analysis, whereas TFL was less likely associated with RF. Recurrent stones, stone size, and multiple stones were predictors of RF requiring further treatment, while LPS and TFL were associated with lesser RF requiring further treatment. In HU ≥ 1000 stones, age, stone size, multiple stones, and LPS were predictors of RF at multivariable analysis, while TFL was less likely associated with RF. Stone size and LPS were predictors of RF requiring further treatment, whereas TFL was associated with RF requiring further treatment. Stone size, LPS, and use of HL are predictors of RF after RIRS for intrarenal stones regardless of stone density. HU should be considered an important parameter in predicting SFR.

Metastatic renal cell carcinoma (mRCC) is a disease that portends poor prognosis despite an increasing number of novel systemic treatment options including new targeted therapies and immunotherapy. Ablative intervention directed at oligometastatic RCC has demonstrated survival benefit. Consequently, developing techniques for improved staging of mRCC on contemporary imaging modalities including X-ray computed tomography (CT), magnetic resonance imaging (MRI) and/or bone scan (BS) is a clinical priority. This is relevant for metastatic deposits too small to characterize or lymph nodes within physiological normality. Prostate-specific membrane antigen (PSMA) is a type II transmembrane glycoprotein highly expressed on prostate cancer epithelial cells. Recently, small molecules targeting the PSMA receptor, linked to radioactive isotopes have been developed for use with positron emission tomography (PET). Despite its nomenclature, PSMA has also been found to be expressed in the neovasculature of non-prostate cancers such as renal cell carcinoma (RCC) and hence PSMA PET/CT imaging has been proposed as an alternative staging modality. Preliminary small studies involving the use of PSMA PET/CT imaging in mRCC have been encouraging with evidence of improved staging sensitivity which has directly led to change in management in some cases. Given these early encouraging reports, we performed a comprehensive narrative review on the available evidence, including the scientific basis for PSMA expression in RCC, the role of PSMA PET/CT imaging with potential clinical implications in mRCC, its limitations and future opportunities.

Objective: The objective of this article is to conduct a contemporary literature review on Wunderlich syndrome, or spontaneous renal haemorrhage (SRH), among pregnant women to describe contemporary aetiology, investigations and management patterns. Methods: A systematic review of MEDLINE and CENTRAL in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines was performed. All articles, including case reports and case series on SRH published from 2000 to 2016, were included. Full-text manuscripts describing SRH among pregnant women were reviewed for clinical parameters, which were collated and analysed. Results: Twenty cases of SRH in pregnant women were identified. The median age and gestation were 32.1 years and 26.5 weeks, respectively, with SRH most commonly occurring in the third trimester (nine patients; 45%) and due to renal neoplasm, specifically angiomyolipoma (AML; 12 patients; 60%), followed by renal artery aneurysm (RAA; five patients; 25%). Surgical intervention (55%) was most commonly used for acute SRH. Foetal demise was not uncommon (15%). Conclusions: SRH in pregnant women is an uncommon but complex urological and obstetric emergency with potentially catastrophic consequences. A multidisciplinary approach is key to timely diagnosis and appropriate management considering the well-being both of mother and foetus. Pre-emptive diagnosis and intervention may reduce complications. Level of evidence: 4

BACKGROUND:Guidelines recommend nephron sparing surgery where possible for patients with T1 renal tumours. The trends of nephron sparing surgery outside the USA are limited, particularly since the introduction of robotic-assisted partial nephrectomy (RAPN). The aim of this study was to describe contemporary surgical management patterns of renal tumours in Australia according to Medicare claims data.METHODS:Claims data according to the Medicare Benefits Schedule on surgical management of renal tumours in adult Australians between January 2000 and December 2016 was collated. Analysis of absolute number, population-adjusted rate and renal cancer-adjusted rate of interventions according to age and gender were performed, as well as proportion of RAPN.RESULTS:Between 2000 and 2016, the rate of partial nephrectomy (PN) increased while radical nephrectomy (RN) remained stable (PN: 0.87-4.16, RN: 6.52-6.70 per 100 000 population). Since 2015, PN has become more common than RN in patients aged 25 to 44 years (0.98 versus 0.95 procedures per 100 000 population). Renal cancer-adjusted rate exhibited a trend towards increasing utilization of PN and reduced RN across all age groups. An increase in overall surgical treatment was observed (25%-41%), mainly due to increased treatment of patients older than 75 years. The proportion of RAPN was seen to rapidly increase (4.7% in 2010 to 58% in 2016).CONCLUSIONS:Treatment utilization for renal masses has markedly changed in Australia according to Medicare claims. PN is increasingly replacing RN in younger patients, and older patients are receiving more surgical treatment. The impact of increased RAPN utilization is yet to be determined.

You have accessJournal of UrologyProstate Cancer: Localized: Surgical Therapy III (MP54)1 Apr 2019MP54-05 LOWER URINARY TRACT SYMPTOMS (LUTS) AFTER ROBOTIC ASSISTED LAPAROSCOPIC PROSTATECTOMY (RALP) IN A LARGE, MULTI-SURGEON COHORT: IMPLICATIONS FOR SURVIVORSHIP AND TREATMENT SELECTION Thomas Ahn, Matthew Roberts*, Andrew Strahan, Gregory Malone, Jason Paterdis, Glen Wood, and Peter Heathcote Thomas AhnThomas Ahn More articles by this author , Matthew Roberts*Matthew Roberts* More articles by this author , Andrew StrahanAndrew Strahan More articles by this author , Gregory MaloneGregory Malone More articles by this author , Jason PaterdisJason Paterdis More articles by this author , Glen WoodGlen Wood More articles by this author , and Peter HeathcotePeter Heathcote More articles by this author View All Author Informationhttps://doi.org/10.1097/01.JU.0000556690.39331.8dAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVES: Prostate cancer (CaP) survivorship after prostatectomy is plagued by negative functional outcomes, such as incontinence and erectile dysfunction. Despite being prevalent in this age group, the effects on lower urinary tract symptoms (LUTS) after surgery are minimally described, thus the aim of this study was to assess LUTS and QOL using the International Prostate Severity Score (IPSS) following RALP. METHODS: A prospectively curated database of 1917 consecutive robotic assisted laparoscopic prostatectomies (RALPs) undertaken over an 8-year period from January 2009 to January 2017 was assessed. Pre-operative information including age, prostate specific antigen (PSA), body mass index (BMI), International Prostate Severity Score (IPSS) and quality of life (QoL) scores were compared to IPSS and QOL scores reported at 12 months post-surgery. RESULTS: Of the 1917 men who underwent RALP, 1470 with complete data were included in the analysis. The mean age, prostate weight and BMI were 62 (± 6.7) years, 51 (± 17.6) g, and 28 kg/m2, respectively. Overall, 57% of men had an improved IPSS score, with 76% (from 60%) scoring IPSS 7 or less post-operatively. 41% reported an improved QoL. 32% of men reported a worse IPSS or QoL. In a subgroup analysis, 63.7% and 90.3% of patients with pre-surgery moderate LUTS (IPSS 8-19) and severe LUTS (20-35) respectively, demonstrated significantly improved IPSS scores (IPSS change of 5 or more) at 1-year post RALP whilst 81.3% with pre-surgery mild LUTS (IPSS 0-7) remained stable (-5 to 5 IPSS change). Our post-RALP mean IPSS scores were lower (less urinary symptoms) when compared with existing literature post-radiation therapy especially in the baseline moderate and severe IPSS scores (IPSS 8 or more). CONCLUSIONS: At 12-months post-RALP, most men reported improved overall LUTS and QoL, with greater benefit seen in those patients with high pre-RALP IPSS and worse LUTS with low IPSS. Further analyses on specific IPSS domains and longer follow up are needed. Source of Funding: None Brisbane, Australia© 2019 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 201Issue Supplement 4April 2019Page: e786-e786 Advertisement Copyright & Permissions© 2019 by American Urological Association Education and Research, Inc.MetricsAuthor Information Thomas Ahn More articles by this author Matthew Roberts* More articles by this author Andrew Strahan More articles by this author Gregory Malone More articles by this author Jason Paterdis More articles by this author Glen Wood More articles by this author Peter Heathcote More articles by this author Expand All Advertisement PDF downloadLoading ...

ANZ Journal of SurgeryVolume 89, Issue 7-8 p. 982-982 LETTER TO THE EDITOR Sodium-glucose linked transporter 2 inhibitor associated post-operative euglycaemic diabetic ketoacidosis: an important consideration for all surgeons Thomas Ahn BPharm (Hons), MBBS (Hons), Corresponding Author Thomas Ahn BPharm (Hons), MBBS (Hons) thomasahn7@gmail.com orcid.org/0000-0002-2808-9970 Department of Urology, Greenslopes Private Hospital, Brisbane, Queensland, Australia Faculty of Medicine, The University of Queensland, Brisbane, Queensland, AustraliaSearch for more papers by this authorPatrick Teloken MBBS, Patrick Teloken MBBS Department of Urology, Greenslopes Private Hospital, Brisbane, Queensland, Australia Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia Department of Urology, QEII Jubilee Hospital, Brisbane, Queensland, AustraliaSearch for more papers by this authorPeter Burke MBBS, FRACS (Urol), Peter Burke MBBS, FRACS (Urol) Department of Urology, Greenslopes Private Hospital, Brisbane, Queensland, Australia Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia Department of Urology, QEII Jubilee Hospital, Brisbane, Queensland, Australia Brisbane Urology Clinic, Brisbane, Queensland, AustraliaSearch for more papers by this author Thomas Ahn BPharm (Hons), MBBS (Hons), Corresponding Author Thomas Ahn BPharm (Hons), MBBS (Hons) thomasahn7@gmail.com orcid.org/0000-0002-2808-9970 Department of Urology, Greenslopes Private Hospital, Brisbane, Queensland, Australia Faculty of Medicine, The University of Queensland, Brisbane, Queensland, AustraliaSearch for more papers by this authorPatrick Teloken MBBS, Patrick Teloken MBBS Department of Urology, Greenslopes Private Hospital, Brisbane, Queensland, Australia Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia Department of Urology, QEII Jubilee Hospital, Brisbane, Queensland, AustraliaSearch for more papers by this authorPeter Burke MBBS, FRACS (Urol), Peter Burke MBBS, FRACS (Urol) Department of Urology, Greenslopes Private Hospital, Brisbane, Queensland, Australia Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia Department of Urology, QEII Jubilee Hospital, Brisbane, Queensland, Australia Brisbane Urology Clinic, Brisbane, Queensland, AustraliaSearch for more papers by this author First published: 04 August 2019 https://doi.org/10.1111/ans.15307Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article. Volume89, Issue7-8July/August 2019Pages 982-982 RelatedInformation

OBJECTIVE:To assess changes in lower urinary tract symptoms (LUTS) and quality of life (QoL) after robot-assisted radical prostatectomy (RARP).PATIENTS AND METHODS:A prospectively curated database of 1917 consecutive RARPs undertaken over an 8-year period from January 2009 to January 2017 was assessed. Preoperative information including age, prostate-specific antigen (PSA) level, body mass index (BMI), International Prostate Symptom Score (IPSS) and QoL score was collected, with IPSS and QoL score compared between baseline (preoperatively) and 12 months post-surgery.RESULTS:Of the 1917 patients who underwent RARP, 1470 with complete data were included in the analysis. Their mean ± sd age, prostate weight and BMI were 62 (±6.7) years, 51 (±17.6) g, and 28 kg/m2 , respectively. Overall, 57% of patients reported an improved IPSS score, whilst 76% reported an IPSS of ≤7 postoperatively. A total of 41% of patients reported an improved QoL and 90.3% of patients with severe preoperative LUTS (IPSS 20-35) demonstrated clinically improved LUTS at 1 year post RARP. The post-RARP mean IPSS in the present study was lower than those reported in the existing post-radiotherapy literature, especially in patients with moderate to severe baseline LUTS (IPSSs ≥ 8).CONCLUSIONS:At 12 months post RARP, most patients reported improved overall LUTS and QoL, with the greatest benefit seen in those patients with a high pre-RARP IPSS. This has implications for treatment selection and preoperative counselling in men being offered active treatment for their prostate cancer. Further analyses of specific IPSS domains and longer follow-up are needed.

BACKGROUND:New-onset chronic kidney disease (CKD) following surgical management of kidney tumors is common. This study evaluated risk factors for new-onset CKD after nephrectomy for T1a renal cell carcinoma (RCC) in an Australian population-based cohort. METHODS:There were 551 RCC patients from the Australian states of Queensland and Victoria included in this study. The primary outcome was new-onset CKD (eGFR <60 mL/min per 1.73 m2 ) and the secondary outcome was new-onset moderate-severe CKD (<45 mL/min per 1.73 m2 ). Multivariable logistic regression was used to evaluate associations between patient, tumor and health-service characteristics and these outcomes. RESULTS:Forty percent (219/551) of patients developed new-onset CKD, and 12% (68/551) experienced new-onset moderate-severe CKD. Risk factors for new-onset CKD were age, lower preoperative eGFR, tumor size >20 mm, radical nephrectomy, lower hospital caseloads (<20 cases/year), and rural place of residence. The associations between rural place of residence and low center volume were a consequence of higher radical nephrectomy rates. CONCLUSION:Risk factors for CKD after nephrectomy generally relate to worse baseline health, or likelihood of undergoing radical nephrectomy. Surgeons in rural centres and hospitals with low caseloads may benefit from formalized integration with specialist centers for continued professional development and case-conferencing, to assist in management decisions.

Objective To conduct a systematic literature review on spontaneous renal hemorrhage (SRH) in a contemporary cohort describing patterns in etiology and treatment. Methods A systematic search of MEDLINE and CENTRAL databases was conducted to include articles, including case reports and case series on SRH published from 2000 to 2016. Full-text manuscripts were reviewed for clinical parameters which were collated and analyzed with univariate methods. Results Seventy-nine publications met inclusion criteria, reporting on 102 cases. Renal neoplasms (56.9%) and polyarteritis nodosa (PAN) (11.8%) remained as the most common overall and vascular causes of SRH, respectively. Angiomyolipoma (AML) was the most common causative renal neoplasm (74.1%), and patients were more likely to be female and present with macroscopic hematuria than those with vasculitis, while malignant neoplasms were more common in men. Proportions of SRH due to malignant neoplasms (specifically renal cell carcinoma, RCC) were reported less than PAN. Among this contemporary series, transarterial embolization (TAE) was most commonly used for acute SRH (42.2%). Conclusions Renal neoplasms remain as the most common cause of SRH, of which AML predominates, while PAN is currently the second most common etiology in acute SRH, replacing RCC. Minimally invasive approaches, such as TAE and conservative/medical management, were preferred to initial surgery. Systematic review registration PROSPERO registration number CRD42017069222.

ANZ Journal of SurgeryVolume 88, Issue 12 p. 1347-1348 IMAGES FOR SURGEONS Recurrent spontaneous renal haemorrhage due to polyarteritis nodosa: a medical cause for a surgical problem Thomas Ahn MBBS, Thomas Ahn MBBS Department of Urology, Princess Alexandra Hospital, Brisbane, Queensland, AustraliaSearch for more papers by this authorMatthew J. Roberts BSc, MBBS, Matthew J. Roberts BSc, MBBS Department of Urology, Princess Alexandra Hospital, Brisbane, Queensland, Australia School of Medicine, The University of Queensland, Brisbane, Queensland, Australia Centre for Clinical Research, The University of Queensland, Brisbane, Queensland, AustraliaSearch for more papers by this authorAnojan Navaratnam MBBS, Anojan Navaratnam MBBS Department of Urology, Princess Alexandra Hospital, Brisbane, Queensland, AustraliaSearch for more papers by this authorJodi Hirst MBBS, FRACS (Urol), Jodi Hirst MBBS, FRACS (Urol) Department of Urology, Princess Alexandra Hospital, Brisbane, Queensland, AustraliaSearch for more papers by this authorSimon Wood MBBS, FRACS (Urol), Simon Wood MBBS, FRACS (Urol) Department of Urology, Princess Alexandra Hospital, Brisbane, Queensland, Australia Centre for Kidney Disease Research, Translational Research Institute, Brisbane, Queensland, AustraliaSearch for more papers by this author Thomas Ahn MBBS, Thomas Ahn MBBS Department of Urology, Princess Alexandra Hospital, Brisbane, Queensland, AustraliaSearch for more papers by this authorMatthew J. Roberts BSc, MBBS, Matthew J. Roberts BSc, MBBS Department of Urology, Princess Alexandra Hospital, Brisbane, Queensland, Australia School of Medicine, The University of Queensland, Brisbane, Queensland, Australia Centre for Clinical Research, The University of Queensland, Brisbane, Queensland, AustraliaSearch for more papers by this authorAnojan Navaratnam MBBS, Anojan Navaratnam MBBS Department of Urology, Princess Alexandra Hospital, Brisbane, Queensland, AustraliaSearch for more papers by this authorJodi Hirst MBBS, FRACS (Urol), Jodi Hirst MBBS, FRACS (Urol) Department of Urology, Princess Alexandra Hospital, Brisbane, Queensland, AustraliaSearch for more papers by this authorSimon Wood MBBS, FRACS (Urol), Simon Wood MBBS, FRACS (Urol) Department of Urology, Princess Alexandra Hospital, Brisbane, Queensland, Australia Centre for Kidney Disease Research, Translational Research Institute, Brisbane, Queensland, AustraliaSearch for more papers by this author First published: 27 February 2017 https://doi.org/10.1111/ans.13914Citations: 3Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article.Citing Literature Volume88, Issue12December 2018Pages 1347-1348 RelatedInformation