Pattern of Change in Renal Function Following Radical Nephrectomy for Renal Cell Carcinoma.

Radical nephrectomy (RN) is an independent risk factor for the development of chronic kidney disease (CKD) in those with renal cell carcinoma (RCC). We aimed to examine the pattern of change in post-operative renal function in patients who underwent RN for RCC over a 3 year period at our institution. We performed a retrospective review of histological and biochemical findings in patients undergoing RN for RCC over a 38 month period. Estimated glomerular filtration rate (eGFR) was recorded pre- and post-operatively and at follow-up. We analysed data on 131 patients (median follow-up 24 months). The proportion of patients with advanced CKD increased significantly at follow-up with 48 (85.7%) patients, classified as having stage 2 CKD pre-operatively, being re-classified as stage 3-5. Mean eGFR was significantly lower pre-operatively (76.6 mL/min/1.73 m2) compared to hospital discharge (61 mL/min/1.73 m2, p < 0.001) and follow-up (55.5 mL/min/1.73 m2, p < 0.001). Those with pT1 tumours sustained a significantly greater decline in eGFR compared to other stages. In conclusion, patients with pT1 a and pT1 b tumours sustain a disproportionate decline in renal function and may benefit the most from NSS.

A review of 100 consecutive sutureless child and adult circumcisions.

BACKGROUND: Circumcision is one of the world's most common operations. Series describing a new technique involving the use of fibrin-based glue have become more apparent in the literature. Here we outline the first 100 such cases for 62 children and 38 adults in our practice describing complications and learning curve. METHODS: We reviewed all cases noting age, indication, cosmetic appearance and any potential complications. Reviews were carried out 2-6 weeks postoperatively. RESULTS: Phimosis accounted for 42% of cases; 58% were for religious reasons. Ages ranged from 6 months to 72 years, with 99% satisfied with the cosmetic immediate postoperative appearance. Three had minor delayed post-op bleeding, none necessitating a return to theatre. One had a reaction to the glue requiring antihistamines for a week. Two postoperative cases of balanitis were reported. CONCLUSION: Sutureless circumcision is a practical alternative to the standard method. This series supports a role for sutureless circumcisions in adults.