Nephrometry scoring systems: their importance for the planning of nephron-sparing surgery and the relationships among them.

In recent years, the development of new imaging techniques and scoring systems have improved the diagnosis and management of small renal masses. Imaging-based nephrometry scoring systems play an interesting role in the planning of nephron-sparing surgery, providing surgeons with the information necessary to determine the complexity of the renal mass, to deliver the appropriate postoperative care, and to predict adverse outcomes. The aim of this study was to review nephrometry scoring systems, evaluating their characteristics and the relationships among them. The urology and radiology communities should decide which nephrometry scoring system will prevail and be used in daily practice.

O diagnóstico e o manejo das pequenas massas renais têm sido aprimorados nos últimos anos com o desenvolvimento de técnicas de imagem e escores que desempenham papel interessante no planejamento da nefrectomia parcial, fornecendo informações importantes ao cirurgião para determinar o tipo de tratamento em relação a complexidade da massa renal, cuidados pós-operatórios e previsão de complicações após as cirurgias. O objetivo deste estudo é revisar os escores de nefrometria, suas características e relações entre eles no cenário da cirurgia. Os serviços de urologia e radiologia devem decidir qual é o melhor escore de nefrometria para ser utilizado na prática diária.

Nephrometry scoring systems: their importance for the planning of nephron-sparing surgery and the relationships among them / Escores nefrométricos: sua importância para o planejamento da nefrectomia parcial e as relações entre eles

Abstract In recent years, the development of new imaging techniques and scoring systems have improved the diagnosis and management of small renal masses. Imaging-based nephrometry scoring systems play an interesting role in the planning of nephron-sparing surgery, providing surgeons with the information necessary to determine the complexity of the renal mass, to deliver the appropriate postoperative care, and to predict adverse outcomes. The aim of this study was to review nephrometry scoring systems, evaluating their characteristics and the relationships among them. The urology and radiology communities should decide which nephrometry scoring system will prevail and be used in daily practice.

Resumo O diagnóstico e o manejo das pequenas massas renais têm sido aprimorados nos últimos anos com o desenvolvimento de técnicas de imagem e escores que desempenham papel interessante no planejamento da nefrectomia parcial, fornecendo informações importantes ao cirurgião para determinar o tipo de tratamento em relação a complexidade da massa renal, cuidados pós-operatórios e previsão de complicações após as cirurgias. O objetivo deste estudo é revisar os escores de nefrometria, suas características e relações entre eles no cenário da cirurgia. Os serviços de urologia e radiologia devem decidir qual é o melhor escore de nefrometria para ser utilizado na prática diária.

Analysis of surgical and histopathological results of robot-assisted partial nephrectomy with use of three or four robotic arms: an early series results

ABSTRACT Objectives: The aim of this study was to evaluate whether criteria exist to guide election between the use the three- or four-arm technique in robotic partial nephrectomy (RPN) instead of just the surgeon's preference. Material and Methods: We performed a retrospective review of 80 patients submitted to RPN from May 2016 to February 2020. The patients were divided into two groups of 40, the first submitted to the surgical procedure with use of three robotic arms and the second with four arms. The group division was performed independently of the complexity of the cases, age or gender of the patients and laterality of the renal lesions. Peri- and postoperative data were analyzed for comparison between the two groups. Results: Both techniques had similar oncological outcomes (positive tumor margins), renal function preservation (warm ischemia time) and hemorrhagic complications (estimated blood loss and renal artery pseudoaneurysm), with a small difference in the need for blood transfusion, favoring the technique with three arms. Conclusions: The two robotic partial nephrectomy techniques had similar oncological and postoperative outcomes, with minimal perioperative complications. The three-arm technique is safe and feasible regardless of the complexity and size of the tumor. Additionally, the use of the three-arm technique reduced surgery costs by US$ 413.00 per patient.

Analysis of surgical and histopathological results of robot-assisted partial nephrectomy with use of three or four robotic arms: an early series results.

OBJECTIVES: The aim of this study was to evaluate whether criteria exist to guide election between the use the three- or four-arm technique in robotic partial nephrectomy (RPN) instead of just the surgeon's preference. MATERIAL AND METHODS: We performed a retrospective review of 80 patients submitted to RPN from May 2016 to February 2020. The patients were divided into two groups of 40, the first submitted to the surgical procedure with use of three robotic arms and the second with four arms. The group division was performed independently of the complexity of the cases, age or gender of the patients and laterality of the renal lesions. Peri- and postoperative data were analyzed for comparison between the two groups. RESULTS: Both techniques had similar oncological outcomes (positive tumor margins), renal function preservation (warm ischemia time) and hemorrhagic complications (estimated blood loss and renal artery pseudoaneurysm), with a small difference in the need for blood transfusion, favoring the technique with three arms. CONCLUSIONS: The two robotic partial nephrectomy techniques had similar oncological and postoperative outcomes, with minimal perioperative complications. The three-arm technique is safe and feasible regardless of the complexity and size of the tumor. Additionally, the use of the three-arm technique reduced surgery costs by US$ 413.00 per patient.

Practical evaluation of the R.E.N.A.L. score system in 150 laparoscopic nephron sparing surgeries

ABSTRACT Introduction: Nephrometric scores play an interesting role in nephron sparring surgery (NSS) planning. The aim of this study is to evaluate if R.E.N.A.L. score (RS) is capable to predict the occurrence of adverse events in laparoscopic NSS. Materials and Methods: We prospectively studied 150 laparoscopic NSS between 2015 and 2018 to evaluate the relationship between RS and incidence of adverse events. Clavien 3 or superior complications, warm ischemia time (WIT) over 30 minutes, tumor violation, positive surgical margins (PSM) and necessity of amplification of renal parenchyma during the resection of the masses to obtain free margins were considered as adverse events. We compared each item of the RS isolated and divided the patients between low risk and high risk. Results: Adverse results occurred in 48 cases (32%). Amplification of the margin of resection was observed in 28 cases (19%). WIT exceeded 30 minutes in 9 cases (6.1%), complications Clavien 3 or superior occurred in 13 cases (9%) and PSM were detected en 6 cases (4%). Comparing the patients with adverse outcomes and each item of the RS we did not find any statistical difference, but when divided into high risk and low risk, we found that patients in the high risk group had a higher tendency to present ad-verse results - 25.84% vs. 44.26% (p=0.03). Conclusions: RS system is a good way to predict adverse outcomes in NSS, especially in cases over 7. Further studies should focus on robotic approach and patient's characteristics other than the masses' aspects.

Practical evaluation of the R.E.N.A.L. score system in 150 laparoscopic nephron sparing surgeries.

INTRODUCTION: Nephrometric scores play an interesting role in nephron sparring surgery (NSS) planning. The aim of this study is to evaluate if R.E.N.A.L. score (RS) is capable to predict the occurrence of adverse events in laparoscopic NSS. MATERIALS AND METHODS: We prospectively studied 150 laparoscopic NSS between 2015 and 2018 to evaluate the relationship between RS and incidence of adverse events. Clavien 3 or superior complications, warm ischemia time (WIT) over 30 minutes, tumor violation, positive surgical margins (PSM) and necessity of amplification of renal parenchyma during the resection of the masses to obtain free margins were considered as adverse events. We compared each item of the RS isolated and divided the patients between low risk and high risk. RESULTS: Adverse results occurred in 48 cases (32%). Amplification of the margin of resection was observed in 28 cases (19%). WIT exceeded 30 minutes in 9 cases (6.1%), complications Clavien 3 or superior occurred in 13 cases (9%) and PSM were detected en 6 cases (4%). Comparing the patients with adverse outcomes and each item of the RS we did not find any statistical difference, but when divided into high risk and low risk, we found that patients in the high risk group had a higher tendency to present ad-verse results - 25.84% vs. 44.26% (p=0.03). CONCLUSIONS: RS system is a good way to predict adverse outcomes in NSS, especially in cases over 7. Further studies should focus on robotic approach and patient's characteristics other than the masses' aspects.

American Confederation of Urology (CAU) experience in minimally invasive partial nephrectomy.

PURPOSE: To describe the perioperative and oncology outcomes in a series of laparoscopic or robotic partial nephrectomies (PN) for renal tumors treated in diverse institutions of Hispanic America from the beginning of their minimally invasive (MI) PN experience through December 2014. METHODS: Seventeen institutions participated in the CAU generated a MI PN database. We estimated proportions, medians, 95 % confidence intervals, Kaplan-Meier curves, multivariate logistic and Cox regression analyses. Clavien-Dindo classification was used. RESULTS: We evaluated 1501 laparoscopic (98 %) or robotic (2 %) PNs. Median age: 58 years. Median surgical time, warm ischemia and intraoperative bleeding were 150, 20 min and 200 cc. 81 % of the lesions were malignant, with clear cell histology being 65 % of the total. Median maximum tumor diameter is 2.7 cm, positive margin is 8.2 %, and median hospitalization is 3 days. One or more postoperative complication was recorded in 19.8 % of the patients: Clavien 1: 5.6 %; Clavien 2: 8.4 %; Clavien 3A: 1.5 %; Clavien 3B: 3.2 %; Clavien 4A: 1 %; Clavien 4B: 0.1 %; Clavien 5: 0 %. Bleeding was the main cause of a reoperation (5.5 %), conversion to radical nephrectomy (3 %) or open partial nephrectomy (6 %). Transfusion rate is 10 %. In multivariate analysis, RENAL nephrometry score was the only variable associated with complications (OR 1.1; 95 % CI 1.02-1.2; p = 0.02). Nineteen patients presented disease progression or died of disease in a median follow-up of 1.37 years. The 5-year progression or kidney cancer mortality-free rate was 94 % (95 % CI 90, 97). Positive margins (HR 4.98; 95 % CI 1.3-19; p = 0.02) and females (HR 5.6; 95 % CI 1.7-19; p = 0.005) were associated with disease progression or kidney cancer mortality after adjusting for maximum tumor diameter. CONCLUSION: Laparoscopic PN in these centers of Hispanic America seem to have acceptable perioperative complications and short-term oncologic outcomes.

The impact of obesity on male fecundity: a Brazilian study.

INTRODUCTION: Obesity has become a major problem in most developed countries. Infertility ranks high among the issues brought by excessive weight gain, particularly as it may affect male sexual function. This study investigated a population of Brazilian infertile men in an attempt to establish a relationship between obesity and infertility. METHODS: A total of 153 infertile men had their anthropometric data collected and were divided into groups according to their body mass index and waist circumference measurements. Sperm parameters including sperm count, concentration, morphology, and motility were compared. RESULTS: Multivariate analysis failed to show a positive correlation between excessive weight gain or increased waist circumference, and sperm alterations in a population of infertile men. CONCLUSIONS: The findings described in this study support the idea that there is no association between obesity and semen alterations in a population of infertile men.

Minilaparoscopy in urology: initial results after 32 cases.

PURPOSE: The use of minilaparoscopic instruments has gained interest in recent years, permitting a less invasive treatment for many surgical procedures. Its application in urological surgeries has not been established yet. METHODS: Between November 2012 and December 2014, 32 patients underwent minilaparoscopic surgeries, using 3.5-mm instruments. The procedures performed included pyeloplasties (16 cases), radical nephrectomies (2), simple nephrectomies (4), renal cyst decortication (5), ureterolithotomy (2) ureteral reimplantation (2) and partial ureterectomy (1). RESULTS: All the procedures were performed minilaparoscopically, except for one simple nephrectomy and one renal cyst decortication that were converted to a standard laparoscopic approach, due to intensive perioperative bleeding. One pyeloplasty had to be reoperated for a urinary fistula repair. All the patients had good-to-excellent cosmetic outcomes, except for one patient who developed keloids at her scars. Functional results were comparable to the ones described in the literature. CONCLUSION: Minilaparoscopy is a feasible option for patients and physicians searching for a even less invasive procedure compared with the laparoscopic approach, with better cosmetic and the same functional and oncologic outcomes.