Urology Commons^™

Cytoreductive Nephrectomy For Patients With Metastatic Sarcomatoid And/Or Rhabdoid Renal Cell Carcinoma Treated With Immune Checkpoint Therapy, Andrew W Hahn, Ritesh R Kotecha, Paul V Viscuse, Alberto C Pieretti, Andrew J Wiele, Eric Jonasch, Chung-Han Lee, Jianjun Gao, Amado J Zurita, Amishi Y Shah, Matthew T Campbell, Padmanee Sharma, Robert J Motzer, Paul Russo, Christopher G Wood, Nizar M Tannir, Martin H Voss, Jose A Karam, A Ari Hakimi, Pavlos Msaouel

Faculty, Staff and Student Publications

BACKGROUND: Renal cell carcinoma (RCC) with sarcomatoid and/or rhabdoid (S/R) dedifferentiation is a highly aggressive tumor with a poor prognosis. Immune checkpoint therapy (ICT) has shown significant treatment efficacy in this subtype. There remains uncertainly regarding the role of cytoreductive nephrectomy (CN) for patients with metastatic RCC (mRCC) with S/R who received ICT.

OBJECTIVE: Here, we report the outcomes with ICT for patients with mRCC and S/R dedifferentiation by CN status.

DESIGN, SETTING, AND PARTICIPANTS: A retrospective review was conducted of 157 patients with sarcomatoid, rhabdoid, or sarcomatoid plus rhabdoid dedifferentiation who received an ICT-based regimen at two cancer centers. …

Comparison Of Patient Satisfaction With Telehealth And In-Clinic Post-Operative Visits, Lillian Matthews, Bryan Renslo, Deborah T. Glassman, Md

Phase 1

Introduction: Telehealth has grown rapidly in the healthcare industry as a time efficient, affordable, and accessible means to provide care. Jefferson’s Department of Urology currently employs telehealth for post-operative visits but its efficacy in post-nephrectomy patients has not been well studied. We aim to demonstrate that patient satisfaction is the same for telehealth versus in-clinic post-operative visits in nephrectomy patients. Secondarily we will examine distance saved for telehealth patients.

Methods: We will administer an IRB approved questionnaire to all nephrectomy patients via the EPIC^® EMR platform after their post-operative visit. Each questionnaire will be specific to telehealth or …

Comparison Of Patient Satisfaction Between Telehealth And In-Clinic Post-Operative Visits, Bryan Renslo, Lillian Matthews, Deborah T. Glassman, Md

Phase 1

Introduction: Telehealth has the potential to be an efficient, affordable, and accessible means to give care. In the field of Urology, its use has large potential but has not been well studied. We hypothesize that the use of telehealth for post-op nephrectomy patients will maintain the same level of patient satisfaction. We also hypothesize that telehealth visits will take less time and save patients money by eliminating the need to travel.

Methods: From May through July 2019, post-nephrectomy patients who consented to the study were given either a telehealth or in-clinic post-operative visit. Outcome metrics and demographics information were obtained …

Urinothorax Caused By Xanthogranulomatous Pyelonephritis, Waiel Abusnina, Hazim Bukamur, Zeynep C. Koc

Internal Medicine

Xanthogranulomatous pyelonephritis is a rare form of chronic pyelonephritis that generally afflicts middle-aged women with a history of recurrent urinary tract infections. Its pathogenesis generally involves calculus obstructive uropathy and its histopathology is characterized by replacement of the renal parenchyma with lipid filled macrophages. This often manifests as an enlarged, nonfunctioning kidney that may be complicated by abscess or fistula. This case details the first reported case of xanthogranulomatous pyelonephritis complicated by urinothorax, which resolved on follow-up chest X-ray after robot-assisted nephrectomy.

Pedunculated And Obstructive Wilms' Tumor: A Rare Presentation In A 2 Year- T Old Male, Leor T. Arbel, Morris Jessop, Osama Al-Omar

Faculty & Staff Scholarship

Wilms' tumor manifesting as an obstructing ureteral mass is extremely rare. Herein, we report an unusual case in which a child presented with a clinical picture concerning for and suggestive of ureteropelvic junction ob- struction (UPJO), but was instead found to have an intrapelvic pedunculated Wilms' tumor with extension into the proximal ureter. We discuss the patient's diagnostic workup, radiographic, operative and pathologic findings, as well as important lessons learned from this unusual case.

Percutaneous Externally Assembled Laparoscopic (Peal) Donor Nephrectomy: A Cohort Pain Comparison, Tyler Miskin, Isaac Kelly, Matthew Pierce, Samuel Abourbih, Duane D. Baldwin

Loma Linda University Student Journal

Donor nephrectomies can be technically demanding. Donors also may not be fully psychologically prepared for their post-operative pain or cosmetic outcome. A novel Percutaneous Externally Assembled Laparoscopic (PEAL) paradigm was developed to decrease incisional pain and laparoscopic scars. The aim of this study is to compare the post-operative outcomes between donor nephrectomies performed with and without the PEAL instruments.

The Feasibility Of Percutaneous Externally Assembled Laparoscopic Nephrectomy: A New Surgical System, Benjamin West, Jerry Thomas, Mohamed Keheila, Nazih Khater, Samuel Abourbih, Salim Cheriyan, Matthew Pierce, Duane D. Baldwin, Jim Shen

Loma Linda University Student Journal

Laparoendoscopic single-site (LESS) nephrectomy provides excellent cosmetic outcomes, but is technically challenging due to loss of triangulation and increased instrument collision. A novel Percutaneous Externally Assembled Laparoscopic (PEAL) surgical system was developed to simplify minimally invasive surgery while providing a nearly scarless outcome. In this study, the feasibility of the PEAL system for nephrectomy was determined.

Clinical Influences In The Multidisciplinary Management Of Small Renal Masses At A Tertiary Referral Center, Costas D. Lallas, Kymora Scotland, Michael Zhang, Daisey Schaeffer, Anne Calvaresi, Leonard G. Gomella, Daniel Brown, Colette Shaw, Edouard J. Trabulsi

Department of Urology Faculty Papers

Introduction We designed a multidisciplinary Small Renal Mass Center to help patients decide among treatment options and individualize therapy for small renal masses. In this model physicians and support staff from multiple specialties work as a team to evaluate and devise a treatment plan for patients at the same organized visit. Methods We retrospectively reviewed the records of 263 patients seen from 2009 to 2014. Monitored patient characteristics included age, Charlson comorbidity index, body mass index, nephrometry score, tumor size and estimated glomerular filtration rate. Univariate and multivariate analyses were performed to identify patient characteristics associated with each treatment choice. …

Treatment Of Exophytic Renal Cancer Smaller Than 3 Cm: Surgery Versus Active Surveillance., Costas D. Lallas, Edouard J. Trabulsi, Samuel D. Kaffenberger, Karim A Touijer

Department of Urology Faculty Papers

No abstract provided.

Effect Of Utilization Of Veno-Venous Bypass Vs. Cardiopulmonary Bypass On Complications For High Level Inferior Vena Cava Tumor Thrombectomy And Concomitant Radical Nephrectomy, Ross M. Simon, Timothy Kim, Patrick Espiritu, Tony Kurian, Wade J. Sexton, Julio M. Pow-Sang, Einar Sverrisson, Philippe E. Spiess

Urology Faculty Publications

Purpose: To determine if patients with renal cell carcinoma (RCC) with levels III and IV tumor thrombi are receive any reduction in complication rate utilizing veno-venous bypass (VVB) over cardiopulmonary bypass (CPB) for high level (III/IV) inferior vena cava (IVC) tumor thrombectomy and concomitant radical nephrectomy.

Materials and Methods: From May 1990 to August 2011, we reviewed 21 patients that had been treated for RCC with radical nephrectomy and concomitant IVC thrombectomy employing either CPB (n =16) or VVB (n=5). We retrospectively reviewed our study population for complication rates and perioperative characteristics.

Results: Our results are reported using the validated …

The Significance Of Functional Renal Obstruction In Predicting Pathologic Stage Of Upper Tract Urothelial Carcinoma., Michael J. Amirian, Kushan Radadia, Hadley Narins, Kelly A. Healy, Scott G. Hubosky, Demetrius H. Bagley, Edouard J. Trabulsi, Costas D. Lallas

Department of Urology Faculty Papers

BACKGROUND AND PURPOSE: Assessing the severity of upper tract urothelial carcinoma (UTUC) has been difficult because of inadequate biopsy specimens. Additional predictive parameters of disease stage would be useful when deciding a treatment plan; it has been suggested that preoperative hydronephrosis can be a surrogate. We examined the relationship between preoperative ipsilateral renal obstruction identified by imaging with final pathologic stage after nephroureterectomy (NU) for UTUC. We then analyzed those patients with ipsilateral renal obstruction and examined if tumor location is associated with an advanced pathologic stage.

METHODS: Patients who underwent NU for UTUC between the years 2001 to 2013 …

Robotic-Assistance Does Not Enhance Standard Laparoscopic Technique For Right-Sided Donor Nephrectomy., Xiaolong S Liu, Hadley W Narins, Warren R Maley, Adam M Frank, Costas D. Lallas

Department of Urology Faculty Papers

OBJECTIVE: To examine donor and recipient outcomes after right-sided robotic-assisted laparoscopic donor nephrectomy (RALDN) compared with standard laparoscopic donor nephrectomy (LDN) and to determine whether robotic-assistance enhances LDN.

MATERIALS & METHODS: From December 2005 to January 2011, 25 patients underwent right-sided LDN or RALDN. An IRB-approved retrospective review was performed of both donor and recipient medical charts. Primary endpoints included both intraoperative and postoperative outcomes.

RESULTS: Twenty right-sided LDNs and 5 RALDNs were performed during the study period. Neither estimated blood loss (76.4 mL vs. 30 mL, P = .07) nor operative time (231 min vs. 218 min, P = …

Rhabdomyolysis After Laparoscopic Nephrectomy., Deborah T. Glassman, William G. Merriam, Edouard J. Trabulsi, Dolores Byrne, Leonard Gomella

Department of Urology Faculty Papers

BACKGROUND AND OBJECTIVES: Laparoscopic renal surgery has become a widely applied technique in recent years. The development of postoperative rhabdomyolysis is a known but rare complication of laparoscopic renal surgery. Herein, 4 cases of rhabdomyolysis and a review of the literature are presented with respect to pathogenesis, treatment, and prevention of this dire complication. METHODS: A retrospective review of over 600 laparoscopic renal operations over the past 8 years was performed. All cases of postoperative rhabdomyolysis were identified. A Medline search was performed to find articles related to the development of postoperative rhabdomyolysis. Cases of rhabdomyolysis developing after laparoscopic renal …