Treatment of angiomyolipoma at a tertiary care centre: the decision between surgery and angioembolization
Stephen Faddegon, MD; Alan So, MD, FRCSC
Abstract

Early but not late allograft nephrectomy reduces allosensitization after transplant failure
Alp Sener, MD, FRCSC; Anand K. Khakhar, MD; Christopher Y. Nguan, MD, FRCSC; Andrew A. House, MD; Anthony M. Jevnikar, MD; Patrick P. Luke, MD, FRCSC
Abstract

How long can patients with renal cell carcinoma wait for surgery without compromising pathological outcomes?
Carlos H Martínez, MD; Paul Martin, MD; Venu Chalasani, MBBS, FRACS; Andrew K. Williams, BMedSc, MBChB, FRACS; Patrick P. W. Luke, MD, FRCSC; Jonathan I. Izawa, MD, FRCSC; Joseph L. Chin, MD, FRCSC; Larry Stitt, MSc; Stephen E. Pautler, BSc, MD, FRCSC
Abstract

Use of artificial neural networks in the management of antenatally diagnosed ureteropelvic junction obstruction
Ilker Seçkiner, MD; Serap Ulusam Seçkiner, PhD; Ömer Bayrak, MD; Sakip Erturhan, MD
Abstract

Radical prostatectomy for high-risk clinically localized prostate cancer: a prospective single institution series
Anthony J. Koupparis, MD; Jeremy P. Grummet, MD; Antonio Hurtado-Coll, MD; Robert H. Bell, MD; Nicholas Buchan, MD; S. Larry Goldenberg, MD, FRCSC; Martin E. Gleave, MD, FRCSC
Abstract

Treatment of angiomyolipoma at a tertiary care centre: the decision between surgery and angioembolization
Abstract
Background: Angiomyolipoma (AML) is a benign renal neoplasm. First-line therapy includes renal preserving surgery or angioembolization (RAE), both with good outcomes in isolated studies. However, there are no comparative randomized trials and no clinical guidelines to help clinicians decide between these treatment modalities. Our study examines the patterns of AML treatment at a tertiary care centre to evaluate how local urologists have been treating this disease.
Methods: This is a retrospective study of all AMLs treated at the Vancouver General Hospital (Vancouver, BC, Canada) over the past 10 years with either RAE or surgical excision. Searches were performed of the radiology and pathology dictation systems, using the following keywords: AML, angiomyolipoma, angioembolization, embolization, surgery, partial nephrectomy and nephrectomy.
Results: At our institution, more AMLs were treated by surgery than angioembolization (42 vs. 17 cases). Angioembolization was more often chosen for cases of multifocal AML (35% vs. 7%) and acute hemorrhage (50% vs. 14%). In the angioembolization cases, particles were the embolic agent of choice (used 40% of the time).
Conclusions: Angioembolization allows rapid patient stabilization in cases of acute hemorrhage, and provides good renal preservation in cases of multifocal AML. It may also be preferred in large masses when partial nephrectomy is not feasible. Surgery should be performed in cases of diagnostic uncertainty or complex vascular anatomy not amenable to RAE. Prospective randomized studies are needed to compare RAE and surgery to better define their indications in sporadic AML.

Early but not late allograft nephrectomy reduces allosensitization after transplant failure
Abstract
Introduction: Allosensitization is a significant obstacle to retransplantation for patients with primary renal graft failure.
Methods: We assessed the impact of allograft nephrectomy (Group I) and weaning of immunosuppression (Group II) on percent panel reactive antibody (%PRA) at various time points after graft failure in 132 patients with a median follow-up of 47 months. Of these, 68% had allograft nephrectomy while 32% were placed on the waiting list and were either taken off immunosuppression, left on prednisone or on low-dose immunosuppressive therapy.
Results: When groups were stratified into early (<6 months) and late (>6 months) graft failure, patients who had transplant nephrectomy for early failure demonstrated a decline in %PRA from 46% at time of graft failure to 27% at last follow-up (p = 0.02); conversely, %PRA continued to rise in Group II experiencing early allograft failure. Both Groups I and II patients with late graft failure maintained elevated %PRA at last follow-up.
Conclusion: Allograft nephrectomy may play a role in limiting allosensitization in patients with early but not late graft failures.

How long can patients with renal cell carcinoma wait for surgery without compromising pathological outcomes?
Abstract
Introduction: Surgical wait times have been shown to be of significance in other malignancies, but limited studies exist in renal cell cancer (RCC). We analyzed surgical waiting time for RCC patients to see if there was an adverse impact on pathological characteristics.
Methods: Our centre triages RCC patients on the basis of perceived tumour risk. The waiting time for surgery is adjusted stage for stage: clinical T1 at 90 days, T2 at 40 days, T3 and T4 at 30 days. We retrospectively reviewed the charts of 354 patients who underwent surgery for RCC. Patients were assessed for pathological upstaging, positive lymph nodes, tumour recurrence and tumour size within each stage. Analysis was performed, using surgical waiting time as a categorical variable, to test for associations with disease recurrence or adverse pathological characteristics.
Results: The median time from the first consultation to surgery was 41 days and the mean follow-up was 26.6 months. Waiting time stage for stage was: clinical T1 at 57.12 days, clinical T2 at 36.8 days, clinical T3 and T4 at 30.32 days. On multivariate analysis, pathological tumour size was associated with progression, whereas no significant association was found between waiting time and upstaging. Higher stage tumours, sarcomatoid pathology and clinical evidence of progression were associated with shorter waiting times for early interventions.
Conclusions: There was no statistically significant evidence for upstaging or progression during the waiting period for our group of patients. The data reinforce previous studies reporting a “safe” period of active surveillance in T1 RCC without affecting their final pathological outcome.

Use of artificial neural networks in the management of antenatally diagnosed ureteropelvic junction obstruction
Abstract
Background: In this study, an artificial neural network (ANN) based system has been developed specifically to help in the management of antenatally diagnosed uretero-pelvic junction (UPJ) obstruction.
Methods: A total of 53 infants with antenatally detected hydronephrosis caused by UPJ obstruction were included in this study. A neural network was developed with the help of a commercially available software package. The patients’ age and sex, renal pelvic diameter, laterality, split renal function and presence of renal scar on radionuclide scan, follow-up times, urine culture results and the presence of symptomatic infections were used as variables. These data were also entered into a statistical software package and linear regression analysis was done.
Results: During the follow-up period, 36 children were observed, and the remaining 17 renal units underwent pyeloplasty. The average sensitivity of the ANN model in predicting the outcome was found to be 92% in the training group and 75% in the validation and test groups. In linear regression, none of the predictors were found to be statistically significant.
Interpretation: In this study, we have demonstrated that the use of ANNs in antenatally diagnosed UPJ obstruction can help the clinician in making treatment decisions, and thus can be useful in daily clinical practice.

Radical prostatectomy for high-risk clinically localized prostate cancer: a prospective single institution series
Abstract
Objective: The objective of this paper is to report on the pathologic and biochemical progression-free outcomes of patients who underwent radical prostatectomy for high-risk localized prostate cancer.
Methods: Data was collected prospectively from 299 patients who underwent radical prostatectomy for high-risk clinically localized prostate cancer by 2 surgeons at a single institution. High risk was defined as 1 or more of 3 adverse factors: prostate-specific antigen (PSA) >20, biopsy Gleason score 8 to 10 and clinical stage T3. PSA recurrence was defined as PSA >0.4 ng/mL or any salvage therapy.
Results: Median age was 63.3 years (46.1-75.9). Median followup was 4.7 years (range 0.5-17.3 years). PSA at diagnosis was >20 ng/mL in 31.4%. Biopsy Gleason score was 8 to 10 in 66.9%. Clinical stage was T3 in 24.4%. 81.6% of patients had a single baseline risk factor, 15.7% had 2 risk factors and 2.7% had all 3 risk factors. Neoadjuvant therapy was administered to 184 patients (61.5%). Pathologic stage was organ-confined in 39.6%, specimenconfined in 26%, non-specimen-confined in 26.4%, and 8% had lymph node positive disease. Overall survival, cancer-specific survival and biochemical progression-free survival was 99%, 99.67% and 70.2%, respectively. Univariate analysis showed that PSA at diagnosis, percentage of cores positive and number of risk factors were predictors of PSA recurrence (p < 0.05). Multivariate analysis showed that PSA at diagnosis was an independent predictor of PSA recurrence (p < 0.05).
Conclusion: Radical prostatectomy is associated with favourable biochemical progression-free, clinical and overall survival in selected men with high-risk localized prostate cancer, and should therefore be considered an option in these patients. Baseline PSA >20 ng/mL is a significant independent predictor of PSA recurrence.

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