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Timing of anti-donor antibody responses affects the survival of kidney transplants

MedicalNewsToday - Mon, 03/06/2017 - 02:00
New research provides insights on transplant recipients' antibody responses against donor kidneys and how the timing of those responses can have important implications.
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Partial Nephrectomy is Associated with Higher Risk of Relapse Compared with Radical Nephrectomy for Clinical Stage T1 Renal Cell Carcinoma Pathologically Upstaged to T3a

We aimed to study recurrence-free survival after partial versus radical nephrectomy for clinical stage T1 renal cell carcinoma among all comers and those upstaged to pathologic stage T3a.
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Cytoreductive Nephrectomy Renal Cell Carcinoma Patients with Venous Tumor Thrombus

Careful selection is critical to identify metastatic renal cell carcinoma (mRCC) patients who are most likely to benefit from cytoreductive nephrectomy (CN). Surgery for mRCC patients with tumor thrombus is complex and may not benefit some patients with very poor overall survival (OS). The objective of this study was to evaluate whether preoperative variables or risk stratification systems could predict OS following CN.
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Editorial Comment

The authors use an innovative predictive tool, the VURx, which has been demonstrated to predict the likelihood of reflux resolution in a younger cohort. They present a retrospective review of patients diagnosed with VUR at ages 2 to 18 years. The VURx is a weighted system that includes female gender, ureteral anomalies, higher grades of VUR and reflux during earlier filling. In the current study resolution/improvement and timing correlated with lower VURx scores but resolution beyond age 24 months did not.
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Editorial Comment

There are clear but controversial guidelines for diagnosing and treating vesicoureteral reflux in children who present at ages 2 to 24 months (reference 11 in article).1 Recommendations are less straightforward in older children. The VURx is a simple validated tool that has been shown to predict spontaneous resolution/improvement in children diagnosed before age 24 months (reference 4 in article). In this study the authors found that the VURx also reliably predicts spontaneous resolution/improvement in older children.
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Evidence-Based versus Personalized Medicine in Pediatric Urology

We live in an age awash in data, much of which are electronically recorded and accessible. “Big data” and their analysis are said to provide answers unobtainable by small scale observation and anecdote, which can then guide appropriate decision making for the individual patient. However, is such evidence-based medicine always true? Or perhaps not all data are equivalent so that the combination of data points is inappropriate at times, resulting in conclusions that are not only inaccurate, but the opposite of truth.
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Evidence-Based versus Personalized Medicine in Pediatric Urology

Terms such as “evidence-based medicine” (EBM) and “evidence-based clinical guidelines” have occasionally been known to induce grimaces and heartburn (or at least heavy sighs and eye-rolling) among urologists. Unsurprisingly, there has been pushback against EBM in favor of more “personalized” approaches; after all, one of the highlights of urology is a large degree of decision making autonomy.
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Chairmen in Academic Urologic Practice: A Descriptive Analysis

Urology (Gold Journal) In Press - Sat, 03/04/2017 - 00:00
To examine and characterize the demographics and scholarly characteristics of academic urology chairmen at the time of appointment.
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No Differences in Population-Based Readmissions After Open and Robotic-Assisted Cystectomy: Implications for Post-Discharge Care

Urology (Gold Journal) In Press - Sat, 03/04/2017 - 00:00
To inform whether readmission reduction strategies should consider surgical approach, we examined readmission differences between open and robotic-assisted radical cystectomy (RARC) using population-based data.
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Efficacy of Standardized Nursing Fertility Counseling on Sperm Banking Rates in Cancer Patients

Urology (Gold Journal) In Press - Sat, 03/04/2017 - 00:00
To examine the effect of brief nurse counseling on sperm banking rates amongst patients prior to initiating chemotherapy.
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Management of urinary incontinence following sub-urethral sling removal

To evaluate urinary incontinence outcomes following synthetic sub-urethral sling removal (SSR) in women.
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Prophylactic Antibiotics and Postoperative Complications for Radical Cystectomy: a population-based analysis in the United States

Infectious, wound and soft tissue events contribute to the morbidity of radical cystectomy, but the association between these events and antibiotic prophylaxis is not clear. We sought to describe the contemporary use of antibiotic prophylaxis in radical cystectomy, adherence to published guidelines, and identify regimens with the lowest rates of infectious events.
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Miniaturized Percutaneous Nephrolithotomy: A Decade of Paradigm Shift in Percutaneous Renal Access

Refers to article:

Tract Sizes in Miniaturized Percutaneous Nephrolithotomy: A Systematic Review from the European Association of Urology Urolithiasis Guidelines Panel

Yasir Ruhayel, Abdulkadir Tepeler, Saeed Dabestani, Steven MacLennan, Aleš Petřík, Kemal Sarica, Christian Seitz, Andreas Skolarikos, Michael Straub, Christian Türk, Yuhong Yuan and Thomas Knoll

Accepted 30 January 2017

Footnotes

Muljibhai Patel Urological Hospital, Nadiad, India

Corresponding author. Department of Urology, Muljibhai Patel Urological Hospital, Nadiad 387001, India. Tel. +91 98 24188685.

Article information

PII: S0302-2838(17)30117-3
DOI: 10.1016/j.eururo.2017.02.028
© 2017 European Association of Urology, Published by Elsevier B.V.

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CheckMate 025 Randomized Phase 3 Study: Outcomes by Key Baseline Factors and Prior Therapy for Nivolumab Versus Everolimus in Advanced Renal Cell Carcinoma

Abstract Background

The randomized, phase 3 CheckMate 025 study of nivolumab (n = 410) versus everolimus (n = 411) in previously treated adults (75% male; 88% white) with advanced renal cell carcinoma (aRCC) demonstrated significantly improved overall survival (OS) and objective response rate (ORR).

Objective

To investigate which baseline factors were associated with OS and ORR benefit with nivolumab versus everolimus.

Design, setting, and participants

Subgroup OS analyses were performed using Kaplan-Meier methodology. Hazard ratios were estimated using the Cox proportional hazards model.

Intervention

Nivolumab 3 mg/kg every 2 wk or everolimus 10 mg once daily.

Results and limitations

The minimum follow-up was 14 mo. Baseline subgroup distributions were balanced between nivolumab and everolimus arms. Nivolumab demonstrated an OS improvement versus everolimus across subgroups, including Memorial Sloan Kettering Cancer Center (MSKCC) and International Metastatic Renal Cell Carcinoma Database Consortium risk groups; age <65 and ≥65 yr; one and two or more sites of metastases; bone, liver, and lung metastases; number of prior therapies; duration of prior therapy; and prior sunitinib, pazopanib, or interleukin-2 therapy. The benefit with nivolumab versus everolimus was noteworthy for patients with poor MSKCC risk (hazard ratio 0.48, 95% confidence interval 0.32–0.70). The mortality rate at 12 mo for all subgroups was lower with nivolumab compared with everolimus. ORR also favored nivolumab. The incidence of grade 3 or 4 treatment-related adverse events across subgroups was lower with nivolumab. Limitations include the post hoc analysis and differing sample sizes between groups.

Conclusion

The trend for OS and ORR benefit with nivolumab for multiple subgroups, without notable safety concerns, may help to guide treatment decisions, and further supports nivolumab as the standard of care in previously treated patients with aRCC.

Patient summary

We investigated the impact of demographic and pretreatment features on survival benefit and tumor response with nivolumab versus everolimus in advanced renal cell carcinoma (aRCC). Survival benefit and response were observed for multiple subgroups, supporting the use of nivolumab as a new standard of care across a broad range of patients with previously treated aRCC.

The trial is registered on ClinicalTrials.gov as NCT01668784.

Take Home Message

Consistent with the benefit demonstrated in previously treated patients with advanced renal cell carcinoma from CheckMate 025, an overall survival and objective response rate benefit with nivolumab versus everolimus was observed for multiple subgroups, including prognostic risk categories, age, number and sites of metastases, and prior therapies.

Keywords: Everolimus, Immune checkpoint inhibitor, Nivolumab, Phase 3, Renal cell carcinoma.

Footnotes

a Gustave Roussy, Villejuif, France

b MD Anderson Cancer Center, University of Texas, Houston, TX, USA

c Beth Israel Deaconess Medical Center, Dana-Farber/Harvard Cancer Center, Boston, MA, USA

d Roswell Park Cancer Institute, Buffalo, NY, USA

e Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD, USA

f Stanford Cancer Institute, Stanford, CA, USA

g University of Washington and Fred Hutchinson Cancer Research Center, Seattle, WA, USA

h Vanderbilt University Medical Center, Nashville, TN, USA

i Fondazione Istituto Nazionale Tumori, Milan, Italy

j Fox Chase Cancer Center, Philadelphia, PA, USA

k Hospital Universitario 12 De Octubre, Madrid, Spain

l Westmead Hospital, Westmead, NSW, Australia

m Aarhus University Hospital, Aarhus, Denmark

n Comprehensive Cancer Center, Helsinki University Central Hospital Cancer Center, Helsinki, Finland

o South West Wales Cancer Institute and Swansea University College of Medicine, Swansea, UK

p University Hospital Essen of University of Duisburg-Essen, Essen, Germany

q Chiba Cancer Center, Chiba, Japan

r Bristol-Myers Squibb, Princeton, NJ, USA

s Memorial Sloan Kettering Cancer Center, New York, NY, USA

Corresponding author. Gustave Roussy, 114 Rue Edouard Vaillant, 94800 Villejuif, France. Tel. +33 1 42115410.

1 Current affiliation: UT Southwestern–Kidney Cancer Program, Dallas, TX, USA.

2 Current affiliation: Robert Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL, USA.

Article information

PII: S0302-2838(17)30099-4
DOI: 10.1016/j.eururo.2017.02.010
© 2017 European Association of Urology, Published by Elsevier B.V.

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Prostate Imaging-Reporting and Data System Version 2 and the Implementation of High-quality Prostate Magnetic Resonance Imaging

Refers to article:

Diagnostic Performance of Prostate Imaging Reporting and Data System Version 2 for Detection of Prostate Cancer: A Systematic Review and Diagnostic Meta-analysis

Sungmin Woo, Chong Hyun Suh, Sang Youn Kim, Jeong Yeon Cho and Seung Hyup Kim

Accepted 25 January 2017

Footnotes

a Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, The Netherlands

b Division of Genitourinary Radiology, Ghent University Hospital, Ghent, Belgium

c Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT, USA

Corresponding author. Department of Radiology and Nuclear Medicine, Radboud University Medical Center, P.O. Box 9101, Nijmegen, The Netherlands. Tel. +31 24 3619196.

Article information

PII: S0302-2838(17)30119-7
DOI: 10.1016/j.eururo.2017.02.030
© 2017 European Association of Urology, Published by Elsevier B.V.

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Minimally Invasive, Laparoscopic, and Robotic-assisted Techniques Versus Open Techniques for Kidney Transplant Recipients: A Systematic Review

Abstract Context

Literature on conventional and minimally invasive operative techniques has not been systematically reviewed for kidney transplant recipients.

Objective

To systematically evaluate, summarize, and review evidence supporting operating technique and postoperative outcome for kidney transplant recipients.

Evidence acquisition

A systematic review was conducted in PubMed–Medline, Embase, and Cochrane Library between 1966 up to September 1, 2016, according to Preferred Reporting Items for Systematic Review and Meta-analysis guidelines. Articles were included and scored by two independent reviewers using Group Reading Assessment and Diagnostic Evaluation (GRADE), Newcastle–Ottawa Quality Assessment Scale (NOS), and Oxford guidelines for level of evidence. Main outcomes were graft survival, surgical site infection, incisional hernia, and cosmetic result. In total, 18 out of 1954 identified publications were included in this analysis.

Evidence synthesis

Included reports described conventional open, minimally invasive open, laparoscopic, and robotic-assisted techniques. General level of evidence of included studies was low (GRADE: 1–3; NOS: 0–4; and Oxford level of evidence: 4–2). No differences in graft or patient survival were found. For open techniques, Gibson incision showed better results than the hockey-stick incision for incisional hernia (4% vs 16%), abdominal wall relaxation (8% vs 24%), and cosmesis. Minimally invasive operative recipient techniques showed lowest surgical site infection (range 0–8%) and incisional hernia rates (range 0–6%) with improved cosmetic result and postoperative recovery. Disadvantages included prolonged cold ischemia time, warm ischemia time, and total operation time.

Conclusions

Although the level of evidence was generally low, minimally invasive techniques showed promising results with regard to complications and recovery, and could be considered for use. For open surgery, the smallest possible Gibson incision appeared to yield favorable results.

Patient summary

In this paper, the available evidence for minimally invasive operation techniques for kidney transplantation was reviewed. The quality of the reviewed research was generally low but suggested possible advantages for minimally invasive, laparoscopic, and robot-assisted techniques.

Take Home Message

The general level of evidence of articles included in this systematic review was low. Minimally invasive techniques showed promising results with regard to complications and recovery. For open surgery, the smallest possible Gibson incision appeared to yield favorable results.

Keywords: Minimally invasive surgery, Laparoscopic surgery, Robotic-assisted surgery, Open surgery, Kidney transplant recipients.

Footnotes

a Department of Surgery, VU Medical Center, Amsterdam, The Netherlands

b Department of Urology, Meander Medical Centre, Amersfoort, The Netherlands

c Department of Surgery, Dutch Cancer Institute/Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands

Corresponding author. Department of Surgery, VU Medical Center, Boelelaan 1118, 1081 HZ Amsterdam, The Netherlands. Tel. +31 20 4444444/+31 6 51919735.

Article information

PII: S0302-2838(17)30109-4
DOI: 10.1016/j.eururo.2017.02.020
© 2017 European Association of Urology, Published by Elsevier B.V.

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