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Urologic Clinics of North America

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https://www.readbyqxmd.com/read/28411925/the-small-renal-mass-and-its-management-in-urologic-practice
#1
EDITORIAL
Alexander Kutikov, Marc C Smaldone
No abstract text is available yet for this article.
May 2017: Urologic Clinics of North America
https://www.readbyqxmd.com/read/28411924/small-renal-mass
#2
EDITORIAL
Samir S Taneja
No abstract text is available yet for this article.
May 2017: Urologic Clinics of North America
https://www.readbyqxmd.com/read/28411923/erratum
#3
(no author information available yet)
No abstract text is available yet for this article.
May 2017: Urologic Clinics of North America
https://www.readbyqxmd.com/read/28411922/postoperative-surveillance-for-renal-cell-carcinoma
#4
REVIEW
Suzanne B Merrill
Postoperative surveillance is an integral part of renal cell carcinoma (RCC) care. However, evidence supporting the practice is lacking. RCC guidelines offer disparate recommendations leading to variation in care. Recently, the effectiveness of guidelines has been questioned and a debate has ignited over whether current protocols merit optimization. Guidelines show limitations in RCC risk assessment, protocol stratification, and definition of duration of follow-up. Alternative strategies have addressed some of these limitations, but further analysis is warranted...
May 2017: Urologic Clinics of North America
https://www.readbyqxmd.com/read/28411921/salvage-surgery-after-renal-mass-ablation
#5
REVIEW
Brian W Cross, Daniel C Parker, Michael S Cookson
Thermal ablative techniques represent treatment options for patients with small renal masses who are not candidates for surgery. The oncologic efficacy of ablation has not been compared in a randomized fashion with nephron-sparing surgery, and the urologist must be knowledgeable regarding the workup and treatment of patients with suspected residual or recurrent tumor following these therapies. Surveillance of patients with tumor recurrence after ablation may be indicated in select circumstances. When patients are deemed appropriate for salvage therapy, most undergo a repeat course of the same ablative modality...
May 2017: Urologic Clinics of North America
https://www.readbyqxmd.com/read/28411920/neoadjuvant-targeted-molecular-therapy-before-renal-surgery
#6
REVIEW
Sumi Dey, Henry N Peabody, Sabrina L Noyes, Brian R Lane
Neoadjuvant targeted molecular therapy may benefit select patients with metastatic renal cell carcinoma. The primary use of this therapy in patients with metastatic disease is to reduce tumor burden, prevent distant metastasis, and increase overall survival. Neoadjuvant therapy may reduce tumor size and tumor complexity, facilitate partial nephrectomy rather than radical nephrectomy, downstage tumor thrombus facilitating thrombectomy, and make unresectable tumors resectable when applied to selected patients...
May 2017: Urologic Clinics of North America
https://www.readbyqxmd.com/read/28411919/complications-of-renal-surgery
#7
REVIEW
William T Berg, Jeffrey J Tomaszewski, Hailiu Yang, Anthony Corcoran
The incidence of the small renal mass continues to increase owing to the aging population and the ubiquity imaging. Most of these tumors are stage I tumors. Management strategies include surveillance, ablation, and extirpation. There is a wide body of literature favoring nephron-sparing approaches. Although nephron-sparing surgery may yield decreased long-term morbidity, it is not without its drawbacks, including a higher rate of complications. Urologists must be attuned to the complications of surgery and develop strategies to minimize risk...
May 2017: Urologic Clinics of North America
https://www.readbyqxmd.com/read/28411918/lymph-node-dissection-for-small-renal-masses
#8
REVIEW
Michael L Blute, Mohit Gupta, Paul L Crispen
Because the majority of small renal masses (SRMs; <4 cm) demonstrate low metastatic potential and can be effectively treated with radical or partial nephrectomy, the role of lymph node dissection (LND) at the time of surgery is unclear. A randomized trial demonstrated no survival benefit of LND in clinically localized renal cell carcinoma. Thus, LND is not recommended routinely for SRMs. For patients with high-risk features or radiographic evidence of lymphadenopathy, however, LND may improve local staging and potentially provide a survival benefit...
May 2017: Urologic Clinics of North America
https://www.readbyqxmd.com/read/28411917/comparative-effectiveness-of-surgical-treatments-for-small-renal-masses
#9
REVIEW
Shree Agrawal, Hillary Sedlacek, Simon P Kim
In the management of small renal masses (SRMs), treatment options include partial nephrectomy (PN), radical nephrectomy (RN), ablation, renal biopsy, and active surveillance. Large series retrospective and meta-analyses demonstrate PN may confer greater preservation of renal function, overall survival, and equivalent cancer control when compared with RN. As newer therapies emerge, we should critically evaluate the risks and benefits associated with the surgical management of SRMs among patients with competing comorbidities, complex tumors, and high-risk disease...
May 2017: Urologic Clinics of North America
https://www.readbyqxmd.com/read/28411916/renal-ischemia-and-functional-outcomes-following-partial-nephrectomy
#10
REVIEW
Joseph R Zabell, Jitao Wu, Chalairat Suk-Ouichai, Steven C Campbell
Renal function after renal cancer surgery is a critical component of survivorship. Quantity and quality of preserved parenchyma are the most important determinants of functional recovery; type and duration of ischemia play secondary roles. Several studies evaluated surgical techniques to minimize ischemia; however, long-term outcomes and potential benefits over clamped partial nephrectomy (PN) have not been consistently demonstrated. Analysis of acute kidney injury (AKI) after PN suggest that most kidneys recover strongly even if AKI is experienced after surgery...
May 2017: Urologic Clinics of North America
https://www.readbyqxmd.com/read/28411915/surgical-techniques-in-the-management-of-small-renal-masses
#11
REVIEW
Michael Daugherty, Gennady Bratslavsky
This article provides a review and outline of the various surgical techniques for small renal masses. It covers surgical approaches and compares outcomes of open versus minimally invasive surgery. The article discusses renal nephrometry scoring and renal ischemia at time of resection. Techniques for controlling the renal hilum and controlling blood flow to the kidney are described. Extirpative techniques for small renal masses are reviewed along with a comparison of outcomes. With careful adherence to key oncologic and surgical principles, negative margins, no complications, and no or minimal decline in renal functional outcomes can be achieved...
May 2017: Urologic Clinics of North America
https://www.readbyqxmd.com/read/28411914/ablative-therapy-for-small-renal-masses
#12
REVIEW
Benjamin L Taylor, S William Stavropoulos, Thomas J Guzzo
The management of small renal masses has become an important public health topic. The increased use of cross-sectional imaging and ultrasound has led to a downward stage migration for the detection of small renal masses. Cancer-specific survival, however, has not reflected this trend accordingly. Although partial nephrectomy has been the mainstay of treatment of small renal masses less than 4 cm, there is growing interest in ablative therapies, such as cryoablation and radiofrequency ablation, due to decreased morbidity...
May 2017: Urologic Clinics of North America
https://www.readbyqxmd.com/read/28411913/active-surveillance-for-the-small-renal-mass-growth-kinetics-and-oncologic-outcomes
#13
REVIEW
Benjamin T Ristau, Andres F Correa, Robert G Uzzo, Marc C Smaldone
Active surveillance for small renal masses (SRMs) is an accepted management strategy for patients with prohibitive surgical risk. Emerging prospectively collected data support the concept that a period of initial active surveillance in an adherent patient population with well-defined criteria for delayed intervention is safe. This article summarizes the literature describing growth kinetics of SRMs managed initially with observation and oncologic outcomes for patients managed with active surveillance. Existing clinical tools to determine and contextualize competing risks to mortality are explored...
May 2017: Urologic Clinics of North America
https://www.readbyqxmd.com/read/28411912/current-role-of-renal-biopsy-in-urologic-practice
#14
REVIEW
Miki Haifler, Alexander Kutikov
Most small renal masses (SRMs) are indolent. In fact, only approximately 80% of SRMs are malignant. Furthermore, SRMs are commonly detected in elderly and comorbid patients. Therefore, opportunities for better care intensity calibration exist. Renal mass biopsy (RMB), when appropriately used, is a valuable clinical tool to help with critical clinical decision-making in patients with SRM. This article summarizes the role of modern RMB in helping gauge care for patients with SRM.
May 2017: Urologic Clinics of North America
https://www.readbyqxmd.com/read/28411911/risk-assessment-in-small-renal-masses-a-review-article
#15
REVIEW
Maxine Sun, Malte Vetterlein, Lauren C Harshman, Steven L Chang, Toni K Choueiri, Quoc-Dien Trinh
The incidence of localized renal cell carcinoma (RCC) has been steadily increasing, in large part because of the increased use of imaging. Optimizing the management of localized RCC has become one of the leading priorities and foremost challenges within the urologic-oncologic community. Adequate risk stratification of patients following the diagnosis of localized RCC has become meaningful in deciding whether to treat, how to treat, and how intensively to treat. This article characterizes the existing risk assessment models that can be useful as treatment decision aids for patients with localized RCC...
May 2017: Urologic Clinics of North America
https://www.readbyqxmd.com/read/28411910/renal-tumor-anatomic-complexity-clinical-implications-for-urologists
#16
REVIEW
Shreyas S Joshi, Robert G Uzzo
Anatomic tumor complexity can be objectively measured and reported using nephrometry. Various scoring systems have been developed in an attempt to correlate tumor complexity with intraoperative and postoperative outcomes. Nephrometry may also predict tumor biology in a noninvasive, reproducible manner. Other scoring systems can help predict surgical complexity and the likelihood of complications, independent of tumor characteristics. The accumulated data in this new field provide provocative evidence that objectifying anatomic complexity can consolidate reporting mechanisms and improve metrics of comparisons...
May 2017: Urologic Clinics of North America
https://www.readbyqxmd.com/read/28411909/current-trends-in-renal-surgery-and-observation-for-small-renal-masses
#17
REVIEW
Siri Drangsholt, William C Huang
There has been a rising incidence of small renal masses and concomitant downward stage migration. This has led to an evolution in the management of kidney cancer from radical nephrectomy to nephron-sparing treatment options including observation. The adoption of partial nephrectomy continues to increase but is still incomplete leading to significant disparities in the delivery of care throughout the country. Surgical excision remains the treatment of choice for small kidney cancers; however, ablative therapies and active surveillance are emerging as reasonable options for select patients...
May 2017: Urologic Clinics of North America
https://www.readbyqxmd.com/read/28411908/hereditary-kidney-cancer-syndromes-and-surgical-management-of-the-small-renal%C3%A2-mass
#18
REVIEW
Kevin A Nguyen, Jamil S Syed, Brian Shuch
The management of patients with hereditary kidney cancers presents unique challenges to clinicians. In addition to an earlier age of onset compared with patients with sporadic kidney cancer, those with hereditary kidney cancer syndromes often present with bilateral and/or multifocal renal tumors and are at risk for multiple de novo lesions. This population of patients may also present with extrarenal manifestations, which adds an additional layer of complexity. Physicians who manage these patients should be familiar with the underlying clinical characteristics of each hereditary kidney cancer syndrome and the suggested surgical approaches and recommendations of genetic testing for at-risk individuals...
May 2017: Urologic Clinics of North America
https://www.readbyqxmd.com/read/28411907/epidemiology-of-the-small-renal-mass-and-the-treatment-disconnect-phenomenon
#19
REVIEW
Robert M Turner, Todd M Morgan, Bruce L Jacobs
The incidence of kidney cancer has steadily increased over recent decades, with most new cases now found when lesions are asymptomatic and small. This downward stage migration relates to the increasing use of abdominal imaging. Three public health epidemics-smoking, hypertension, and obesity-also play roles in the increase. Treatment mirrors the rise in incidence, with increasing interest in nephron-sparing therapies. Despite earlier detection and increasing treatment, the mortality rate has not decreased. This treatment disconnect phenomenon highlights the need to decrease unnecessary treatment of indolent tumors and address modifiable risk factors to reduce incidence and mortality...
May 2017: Urologic Clinics of North America
https://www.readbyqxmd.com/read/27908377/management-of-urethral-strictures
#20
EDITORIAL
Lee C Zhao
No abstract text is available yet for this article.
February 2017: Urologic Clinics of North America
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