RENAL nephrometry score predicts surgery type independent of individual surgeon's use of nephron-sparing surgery.

OBJECTIVE: To evaluate whether surgeon factors, such as training and experience, have a strong impact on selection of surgical approach for treating renal cancers. Nephron-sparing surgery (NSS) has become the reference standard for tumors that are amenable to such an approach. Tumor size and configuration are important predictors of usage of NSS. The RENAL nephrometry score (RNS) has been developed to standardize reporting of tumor complexity, but the performance of this method within individual surgeons' practices, particularly in the community-based setting, has not been evaluated previously. METHODS: Clinical data and RNS were collected retrospectively for 300 cases performed by 5 different surgeons with varying NSS usage rates (31-74%). RESULTS: Mean RNS for patients undergoing NSS (6.0) and radical nephrectomy (RN) (9.3) differed significantly (P <.0001), as did tumor size (2.8 vs 6.3 cm, P <.0001). RNS was a better predictor of surgery type (R(2) = .55) than was tumor size (R(2) = .43) for all 5 surgeons. In univariable analysis, individual surgeon, surgery year, glomerular filtration rate, tumor size, RNS, and each RNS component predicted NSS vs RN (each P <.05). In multivariable analysis, surgeon, tumor size, exophytic amount, and nearness to collecting system were independent predictors of NSS usage (P <.001). CONCLUSION: Despite significant variation in NSS usage by individual surgeons at a community-based health system, RNS appears to be valid for both low and high usage. With increasing usage of NSS worldwide, RNS appears to reflect current patterns and may inform future practice for surgeons of all backgrounds.

Photoselective potassium-titanyl-phosphate laser vaporization of the benign obstructive prostate: observations on long-term outcomes.

PURPOSE: We present long-term observations on photoselective vaporization of the prostate in a prospectively studied cohort of men with obstructive benign prostatic hyperplasia. MATERIALS AND METHODS: Obstructive benign prostatic hyperplasia in 94 men was treated with transurethral near contact vaporization with potassium-titanyl-phosphate laser with the patient under general or spinal anesthesia. Baseline characteristics, perioperative data, postoperative outcomes and adverse events were recorded. RESULTS: Mean prostate volume was 45 ml (range 13 to 136). Mean lasing time was 47 minutes (range 10 to 99), and there was minimal blood loss and no evidence of fluid absorption. All 94 men were outpatients and all but 1 became catheter-free in less than 24 hours. Baseline mean American Urological Association symptom index score was 22, quality of life score 4.5, peak urinary flow rate 7.8 ml per second and post-void residual urine volume 197 ml. After surgery percentage changes from baseline in mean values of these parameters, reflecting significant (p <0.0001) improvement at 1, 2, 3 and 5 years, ranged from 83% to 88%, 86% to 90%, 170% to 252% and 76% to 89%, respectively. Complications were mild, and included transient dysuria (6%), delayed hematuria (3%), bladder neck contracture (2%) and 2-day retention (1%). No patient had incontinence or newly developed impotence, but up to 26% of the sexually active men experienced retrograde ejaculation. Postoperatively, low stage prostate cancer was detected in 5% of the patients. CONCLUSIONS: : Despite limitations our long-term experience and the literature suggest that significant improvements in symptomatic and urodynamic outcomes of photo-selective vaporization of the prostate are achievable and sustainable.