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Article ; Online: Infertility considerations in klinefelter syndrome: From origin to management.

Deebel, Nicholas A / Bradshaw, Aaron W / Sadri-Ardekani, Hooman

Best practice & research. Clinical endocrinology & metabolism

2020 Volume 34, Issue 6, Page(s) 101480

Abstract: Klinefelter syndrome (KS) is defined as the presence of one or more extra "X" chromosome in a male patient. It affects approximately 1 in 600 newborn males and the most common chromosomal abnormality, leading to male hypogonadism and infertility. There ... ...

Abstract	Klinefelter syndrome (KS) is defined as the presence of one or more extra "X" chromosome in a male patient. It affects approximately 1 in 600 newborn males and the most common chromosomal abnormality, leading to male hypogonadism and infertility. There is a lack of data supporting best practices for KS patients' care. In this paper we review controversial issues in KS research ranging from mechanisms of variation in KS phenotype to abnormalities resulting in reduced sperm production to successful sperm retrieval disparities after testicular sperm extraction (TESE). Translation to live birth and offspring health is also examined. Finally, medical therapies used to optimize the hormonal status and chances of fertility in KS patients are reviewed. We will also discuss the experimental spermatogonial stem cell (SSC) treatments, which are considered the future for TESE negative patients.
MeSH term(s)	Humans ; Infant, Newborn ; Infertility, Male/diagnosis ; Infertility, Male/etiology ; Infertility, Male/genetics ; Infertility, Male/therapy ; Klinefelter Syndrome/complications ; Klinefelter Syndrome/diagnosis ; Klinefelter Syndrome/genetics ; Klinefelter Syndrome/therapy ; Male ; Neonatal Screening ; Sperm Retrieval ; Spermatozoa/abnormalities ; Spermatozoa/metabolism ; Testis/metabolism ; Testis/pathology
Language	English
Publishing date	2020-12-15
Publishing country	Netherlands
Document type	Journal Article ; Review
ZDB-ID	2052339-7
ISSN	1878-1594 ; 1532-1908 ; 1521-690X
ISSN (online)	1878-1594 ; 1532-1908
ISSN	1521-690X
DOI	10.1016/j.beem.2020.101480
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Article ; Online: Examining potential mechanisms of testicular fibrosis in Klinefelter Syndrome: A review of current understanding.

Bradshaw, Aaron W / Deebel, Nicholas A / Xu, Mark C / Kogan, Stanley / Atala, Anthony / Sadri-Ardekani, Hooman

Andrology

2022 Volume 11, Issue 3, Page(s) 435–443

Abstract: Background: Men with Klinefelter Syndrome develop some degree of seminiferous tubule degeneration, hyalinization, and fibrosis by adulthood. However, the pathophysiology surrounding testicular fibrosis in Klinefelter Syndrome patients remains ... ...

Abstract	Background: Men with Klinefelter Syndrome develop some degree of seminiferous tubule degeneration, hyalinization, and fibrosis by adulthood. However, the pathophysiology surrounding testicular fibrosis in Klinefelter Syndrome patients remains incompletely understood. Objectives: To perform a systematic review of literature studying the mechanisms of fibrosis initiation or propagation in Klinefelter Syndrome testes. Materials/methods: PubMed was searched systematically for articles specific to Klinefelter Syndrome and the process of fibrosis. Articles that did not contain original data or specifically addressed the target material were excluded. Additional references were extracted when pertinent from the reference lists of included studies. Results: Primary search yielded 139 articles for abstract review, which was narrowed to 16 for full-text review. Following full-text review, eight contained original data and met topic criteria, with one paper added from reference review for a total of nine papers. Discussion: The date range for included papers was 1992-2022. The proposed mechanisms of fibrosis mainly were centered around the impact of altered Sertoli cells on germ cells, the hormonal impact on Leydig cells, the inflammation mediated by mast cells, or the fibrous extracellular matrix deposition by peritubular myoid cells. Additionally, discussions of the role of the altered microvasculature and the specific proteins involved in the blood-testis barrier or the seminiferous tubule architecture are reviewed. Recent papers have incorporated advanced sequencing and offer future directions for targeted gene expression analysis. Still, much of the published data consists solely of immunohistological assessment by age range, creating difficulties in extrapolating causality. Conclusion: The specific initiating factors of fibrosis of the seminiferous tubules and the propagation mechanisms unique to Klinefelter Syndrome remain incompletely understood with a relative paucity of data. Nonetheless, academic interest is increasing in this field as it may further elucidate the pathophysiology behind Klinefelter syndrome.
MeSH term(s)	Male ; Humans ; Adult ; Klinefelter Syndrome/complications ; Testis/metabolism ; Seminiferous Tubules/metabolism ; Sertoli Cells/metabolism ; Fibrosis
Language	English
Publishing date	2022-10-27
Publishing country	England
Document type	Systematic Review ; Journal Article ; Review
ZDB-ID	2696108-8
ISSN	2047-2927 ; 2047-2919
ISSN (online)	2047-2927
ISSN	2047-2919
DOI	10.1111/andr.13327
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Article ; Online: In vitro evidence against productive SARS-CoV-2 infection of human testicular cells: Bystander effects of infection mediate testicular injury.

Giannakopoulos, Stefanos / Strange, Daniel P / Jiyarom, Boonyanudh / Abdelaal, Omar / Bradshaw, Aaron W / Nerurkar, Vivek R / Ward, Monika A / Bakse, Jackson / Yap, Jonathan / Vanapruks, Selena / Boisvert, William A / Tallquist, Michelle D / Shikuma, Cecilia / Sadri-Ardekani, Hooman / Clapp, Philip / Murphy, Sean V / Verma, Saguna

PLoS pathogens

2023 Volume 19, Issue 5, Page(s) e1011409

Abstract: The hallmark of severe COVID-19 involves systemic cytokine storm and multi-organ injury including testicular inflammation, reduced testosterone, and germ cell depletion. The ACE2 receptor is also expressed in the resident testicular cells, however, SARS- ... ...

Abstract	The hallmark of severe COVID-19 involves systemic cytokine storm and multi-organ injury including testicular inflammation, reduced testosterone, and germ cell depletion. The ACE2 receptor is also expressed in the resident testicular cells, however, SARS-CoV-2 infection and mechanisms of testicular injury are not fully understood. The testicular injury could be initiated by direct virus infection or exposure to systemic inflammatory mediators or viral antigens. We characterized SARS-CoV-2 infection in different human testicular 2D and 3D culture systems including primary Sertoli cells, Leydig cells, mixed seminiferous tubule cells (STC), and 3D human testicular organoids (HTO). Data shows that SARS-CoV-2 does not productively infect any testicular cell type. However, exposure of STC and HTO to inflammatory supernatant from infected airway epithelial cells and COVID-19 plasma decreased cell viability and resulted in the death of undifferentiated spermatogonia. Further, exposure to only SARS-CoV-2 Envelope protein caused inflammatory response and cytopathic effects dependent on TLR2, while Spike 1 or Nucleocapsid proteins did not. A similar trend was observed in the K18-hACE2 transgenic mice which demonstrated a disrupted tissue architecture with no evidence of virus replication in the testis that correlated with peak lung inflammation. Virus antigens including Spike 1 and Envelope proteins were also detected in the serum during the acute stage of the disease. Collectively, these data strongly suggest that testicular injury associated with SARS-CoV-2 infection is likely an indirect effect of exposure to systemic inflammation and/or SARS-CoV-2 antigens. Data also provide novel insights into the mechanism of testicular injury and could explain the clinical manifestation of testicular symptoms associated with severe COVID-19.
MeSH term(s)	Male ; Mice ; Animals ; Humans ; COVID-19/metabolism ; Testis ; SARS-CoV-2 ; Bystander Effect ; Inflammation/metabolism ; Mice, Transgenic
Language	English
Publishing date	2023-05-18
Publishing country	United States
Document type	Journal Article ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't
ZDB-ID	2205412-1
ISSN	1553-7374 ; 1553-7374
ISSN (online)	1553-7374
ISSN	1553-7374
DOI	10.1371/journal.ppat.1011409
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Article: Nephrostomy tubes placed emergently prior to percutaneous renal stone surgery are practical for obtaining access.

Bradshaw, Aaron W / Bechis, Seth K / Cobb, Kaitlan D / Friedlander, David F / DiPina, Thomas / Sur, Roger L

Archivos espanoles de urologia

2020 Volume 73, Issue 9, Page(s) 837–842

Abstract: Objectives: Renal access in percutaneous nephrolithotomy (PCNL) may be obtained via a pre-existing nephrostomy tube (NT) tract; however, emergent NTs are not always ideal for subsequent surgery. We sought to determine the rate of NT tract usability and ... ...

Title translation	La colocación de nefrostomía percutánea antes de la cirugía percutánea de la litiasis facilita la obtención del acceso.
Abstract	Objectives: Renal access in percutaneous nephrolithotomy (PCNL) may be obtained via a pre-existing nephrostomy tube (NT) tract; however, emergent NTs are not always ideal for subsequent surgery. We sought to determine the rate of NT tract usability and assess factors related to the usability of emergently placed NTs. Methods: A retrospective review was performed of UC San Diego subjects undergoing percutaneous renal surgery between January 2016 and October 2018. Demographics and peri-operative variables were collected. The primary outcome was the usability of NT tract for dilation and instrumentation. "Usable" indicated a tract in which PCNL could be completed; "unusable" indicated lack of dilation and the requirement of additional tract(s) for PCNL. Results: 35 PCNL cases had previous emergently placed NT which were indwelling at time of percutaneous surgery. 51% of these NT tracts (18/35) were deemed usable and dilated for PCNL. No significant difference was seen between usable and unusable NT groups for number of dilated tracts during PCNL (p=0.13), or either the location of indwelling NT (p=0.96) or renal stones (p=0.95). In the usable NT tract cohort PCNL access was via the lower pole 56% of the time, where as when previous NT tracts were deemed unusable, a separate upper-pole access was obtained intra-operatively 53% of the time (p<0.01). Conclusions: Pre-existing, emergent NTs served a ssufficient PCNL access tracts in over half of recorded cases. Contrary to recently published reports, the utility of pre-existing NTs appears to vary among health systems. Other variables, including the desired location of PCNL appear to directly influence the like lihood of NT tract usability.
MeSH term(s)	Humans ; Kidney ; Kidney Calculi/surgery ; Nephrolithotomy, Percutaneous ; Nephrostomy, Percutaneous ; Retrospective Studies ; Treatment Outcome
Language	Spanish
Publishing date	2020-11-02
Publishing country	Spain
Document type	Journal Article
ZDB-ID	211673-x
ISSN	0004-0614
ISSN	0004-0614
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Article: In vitro evidence against productive SARS-CoV-2 infection of human testicular cells: Bystander effects of infection mediate testicular injury.

Giannakopoulos, Stefanos / Strange, Daniel P / Jiyarom, Boonyanudh / Abdelaal, Omar / Bradshaw, Aaron W / Nerurkar, Vivek R / Ward, Monika A / Bakse, Jackson / Yap, Jonathan / Vanapruks, Selena / Boisvert, William / Tallquist, Michelle D / Shikuma, Cecilia / Sadri-Ardekani, Hooman / Clapp, Philip / Murphy, Sean / Verma, Saguna

bioRxiv : the preprint server for biology

2022

Abstract: The hallmark of severe COVID-19 involves systemic cytokine storm and multi-organ failure including testicular injury and germ cell depletion. The ACE2 receptor is also expressed in the resident testicular cells however, SARS-CoV-2 infection and ... ...

Abstract	The hallmark of severe COVID-19 involves systemic cytokine storm and multi-organ failure including testicular injury and germ cell depletion. The ACE2 receptor is also expressed in the resident testicular cells however, SARS-CoV-2 infection and mechanisms of testicular injury are not fully understood. The testicular injury can likely result either from direct virus infection of resident cells or by exposure to systemic inflammatory mediators or virus antigens. We here characterized SARS-CoV-2 infection in different human testicular 2D and 3D models including primary Sertoli cells, Leydig cells, mixed seminiferous tubule cells (STC), and 3D human testicular organoids (HTO). Data shows that SARS-CoV-2 does not establish a productive infection in any testicular cell types. However, exposure of STC and HTO to inflammatory supernatant from infected airway epithelial cells and COVID-19 plasma depicted a significant decrease in cell viability and death of undifferentiated spermatogonia. Further, exposure to only SARS-CoV-2 envelope protein, but not Spike or nucleocapsid proteins led to cytopathic effects on testicular cells that was dependent on the TLR2 receptor. A similar trend was observed in the K18h-ACE2 mouse model which revealed gross pathology in the absence of virus replication in the testis. Collectively, data strongly indicates that the testicular injury is not due to direct infection of SARS-CoV-2 but more likely an indirect effect of exposure to systemic inflammation or SARS-CoV-2 antigens. Data also provide novel insights into the mechanism of testicular injury and could explain the clinical manifestation of testicular symptoms associated with severe COVID-19.
Language	English
Publishing date	2022-09-22
Publishing country	United States
Document type	Preprint
DOI	10.1101/2022.09.21.508904
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Article ; Online: Disparities in Cancer Specific and Overall Survival Outcomes in African Americans With Renal Cell Carcinoma: Analysis From the International Marker Consortium for Renal Cancer (INMARC).

Meagher, Margaret F / Patil, Dattatraya / Saito, Kazutaka / Javier-Desloges, Juan F / Bradshaw, Aaron W / Patel, Sunil H / Cotta, Brittney H / Yasuda, Yosuke / Eldefrawy, Ahmed / Ghali, Fady / Nasseri, Ryan / Wan, Fang / Fujii, Yasuhisa / Master, Viraj / Derweesh, Ithaar H

Urology

2022 Volume 163, Page(s) 164–176

Abstract: Objective: To investigate association of African-American race and survival in Renal Cell Carcinoma (RCC).: Patients and methods: We queried the International Marker Consortium for Renal Cancer database for patients who underwent partial or radical ( ... ...

Abstract	Objective: To investigate association of African-American race and survival in Renal Cell Carcinoma (RCC). Patients and methods: We queried the International Marker Consortium for Renal Cancer database for patients who underwent partial or radical (RN) nephrectomy. The cohort was divided into African American (AA) and non-African American (NAA) patients. Primary outcome was all-cause mortality. Secondary outcome was cancer-specific mortality. Multivariable Analysis and Kaplan-Meier Analysis were used to elucidate predictive factors and survival outcomes. Results: Three thousand eight hundred and ninety-three patients were analyzed (AA, n = 564/NAA, n = 3329). AA had greater Stage I (73.8% vs 63.9%, P <.001) and papillary RCC (29.8% vs 8.5%, P <.001). Multivariable Analysis revealed increasing age (HR = 1.03, P <.001), AA (HR = 1.24, P = .027), higher stage (HR = 1.30-3.19, P <.001), RN (HR = 2.45, P <.001), clear cell (HR = 1.23, P <.001), positive margin (HR = 1.34, P .004), and high-grade (HR = 1.58, P <.001) to be associated with worsened all-cause mortality. Increasing age (HR = 1.02, P <.001), AA (HR = 1.48, P = .025), RN (HR = 2.98, P <.001), high-grade (HR = 3.11, P <.001), and higher stage (HR = 3.03-13.2, P <.001) were predictive for cancer-specific mortality. Kaplan-Meier Analysis revealed worsened 5-year overall survival for AA in stage I (80% vs 88%, P = .001), stage III (26% vs 70%, P = .001), and stage IV (23% vs 44%, P = .009). Five-year cancer-specific survival was worse for AA in stage III (36% vs 81%, P <.001) and stage IV (30% vs 49%, P = .007). Conclusion: Despite presenting with more indolent histology and lower stage, African-Americans were at greater risk for diminished survival, faring worse in overall survival for all stages and cancer-specific survival in for stage III/IV RCC. Further investigation into factors associated with these disparities is warranted.
MeSH term(s)	African Americans ; Biomarkers ; Carcinoma, Renal Cell/pathology ; Humans ; Kidney Neoplasms/pathology ; Neoplasm Staging ; Nephrectomy ; Retrospective Studies
Chemical Substances	Biomarkers
Language	English
Publishing date	2022-01-05
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	192062-5
ISSN	1527-9995 ; 0090-4295
ISSN (online)	1527-9995
ISSN	0090-4295
DOI	10.1016/j.urology.2021.12.022
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Article: Antibiotics are not necessary during routine cystoscopic stent removal: A randomized controlled trial at UC San Diego.

Bradshaw, Aaron W / Pe, Mark / Bechis, Seth K / Dipina, Thomas / Zupkas, Paul / Abbott, Joel E / Papagiannopoulos, Dimitri / Cobb, Kaitlan D / Sur, Roger L

Urology annals

2020 Volume 12, Issue 4, Page(s) 373–378

Abstract: Introduction: Current American Urological Association (AUA) Best Practice Statement recommends antibiotic prophylaxis for cystoscopy with manipulation, including stent removal; although no Level 1b trials explicitly address prophylaxis for stent removal. ...

Abstract	Introduction: Current American Urological Association (AUA) Best Practice Statement recommends antibiotic prophylaxis for cystoscopy with manipulation, including stent removal; although no Level 1b trials explicitly address prophylaxis for stent removal. We sought to determine the efficacy of prophylactic antibiotics to prevent infectious complications after stent removal. Materials and methods: Following institutional review board approval, patients undergoing removal of ureteral stent placed during stone surgery were recruited from July 2016 to March 2019. Patients were recruited at the time of stent removal and randomized to treatment (single dose 500 mg oral ciprofloxacin) or control group (no antibiotics). Telephone contact was attempted within 14 days of stent removal to assess for urinary tract infection (UTI) symptoms, antibiotic prescriptions, or Emergency Department visits. Results: Seventy-seven patients were enrolled, with 58 meeting final inclusion criteria for the analysis (33 treatment, 25 controls). No differences were seen with clinical and demographic variables, except a higher body mass index in the treatment group ( Conclusions: We found a low infectious complication rate regardless of antibiotic prophylaxis use during cystoscopic stent removal. The necessity of antibiotics during routine cystoscopic stent removal warrants possible reevaluation of the AUA best practice statement.
Language	English
Publishing date	2020-10-15
Publishing country	India
Document type	Journal Article
ISSN	0974-7796
ISSN	0974-7796
DOI	10.4103/UA.UA_130_19
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Article ; Online: Impact of positive surgical margins on survival after partial nephrectomy in localized kidney cancer: analysis of the National Cancer Database.

Ryan, Stephen T / Patel, Devin N / Ghali, Fady / Patel, Sunil H / Sarkar, Reith / Yim, Kendrick / Eldefrawy, Ahmed / Cotta, Brittney H / Bradshaw, Aaron W / Meagher, Margaret F / Hamilton, Zachary A / Murphy, James D / Derweesh, Ithaar H

Minerva urology and nephrology

2020 Volume 73, Issue 2, Page(s) 233–244

Abstract: Background: The impact of positive surgical margins (PSM) on outcomes in partial nephrectomy (PN) is controversial. We investigated impact of PSM for patients undergoing PN on overall survival (OS) in different stages of renal cell carcinoma (RCC).: ... ...

Abstract	Background: The impact of positive surgical margins (PSM) on outcomes in partial nephrectomy (PN) is controversial. We investigated impact of PSM for patients undergoing PN on overall survival (OS) in different stages of renal cell carcinoma (RCC). Methods: Retrospective analysis of patients from the US National Cancer Database who underwent PN for cT1a-cT2b N0M0 RCC between 2004-13. Patients were stratified by pathological stage (pT1a, pT1b, pT2a, pT2b, and pT3a [upstaged]) and analyzed by margin status. Cox Regression multivariable analysis (MVA) was performed to investigate associations of PSM and covariates on all-cause mortality (ACM). Kaplan-Meier analysis (KMA) of OS was performed for PSM versus negative margin (NSM) by pathological stage. Sub-analysis of Charlson Comorbidity Index 0 (CCI=0) subgroup was conducted to reduce bias from comorbidities. Results: We analyzed 42,113 PN (pT1a: 33,341 [79.2%]; pT1a, pT1b: 6689 [15.9%]; pT2a: 757 [1.8%]; pT2b: 165 [0.4%]; and pT3a: upstaged 1161 [2.8%]). PSM occurred in 6.7% (2823) (pT1a: 6.5%, pT1b: 6.3%, pT2a: 5.9%, pT2b: 6.1%, pT3a: 14.1%, P<0.001). On MVA, PSM was associated with 31% increase in ACM (HR 1.31, P<0.001), which persisted in CCI=0 sub-analysis (HR: 1.25, P<0.001). KMA revealed negative impact of PSM vs. NSM on 5-year OS: pT1 (87.3% vs. 90.9%, P<0.001), pT2 (86.7% vs. 82.5%, P=0.48), and upstaged pT3a (69% vs. 84.2%, P<0.001). Conclusions: PSM after PN was independently associated with across-the-board decrement in OS, which worsened in pT3a disease and persisted in sub-analysis of patients with CCI=0. PSM should prompt more aggressive surveillance or definitive resection strategies.
MeSH term(s)	Adolescent ; Adult ; Aged ; Aged, 80 and over ; Carcinoma, Renal Cell/mortality ; Carcinoma, Renal Cell/pathology ; Carcinoma, Renal Cell/surgery ; Databases, Factual ; Female ; Humans ; Kidney Neoplasms/mortality ; Kidney Neoplasms/pathology ; Kidney Neoplasms/surgery ; Male ; Margins of Excision ; Middle Aged ; Neoplasm Staging ; Nephrectomy/methods ; Nephrectomy/mortality ; Regression Analysis ; Retrospective Studies ; Survival Analysis ; Treatment Outcome ; United States/epidemiology ; Young Adult
Language	English
Publishing date	2020-08-04
Publishing country	Italy
Document type	Journal Article
ZDB-ID	3062840-4
ISSN	2724-6442
ISSN (online)	2724-6442
DOI	10.23736/S2724-6051.20.03728-5
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Article ; Online: Systemic therapy in the management of localized and locally advanced renal cell carcinoma: Current state and future perspectives.

Berquist, Sean W / Yim, Kendrick / Ryan, Stephen T / Patel, Sunil H / Eldefrawy, Ahmed / Cotta, Brittney H / Bradshaw, Aaron W / Meagher, Margaret F / Bindayi, Ahmet / McKay, Rana R / Autorino, Riccardo / Staehler, Michael / Derweesh, Ithaar H

International journal of urology : official journal of the Japanese Urological Association

2019 Volume 26, Issue 5, Page(s) 532–542

Abstract: Systemic therapy strategies in the setting of localized and locally advanced renal cell carcinoma have continued to evolve in two directions: (i) as adjuvant therapy (to reduce the risk of recurrence or progression in high-risk localized groups); or (ii) ...

Abstract	Systemic therapy strategies in the setting of localized and locally advanced renal cell carcinoma have continued to evolve in two directions: (i) as adjuvant therapy (to reduce the risk of recurrence or progression in high-risk localized groups); or (ii) as neoadjuvant therapy as a strategy to render primary renal tumors amenable to planned surgical resection in settings where radical resection or nephron-sparing surgery was not thought to be safe or feasible. In the realm of adjuvant therapy, the results of adjuvant therapy phase III randomized clinical trials have been mixed and contradictory; nevertheless, the findings of the landmark Sunitinib Treatment of Renal Adjuvant Cancer study have led to approval of sunitinib as an adjuvant agent in the USA. In the realm of neoadjuvant therapy, presurgical tumor reduction has been shown in a number of phase II studies utilizing targeted molecular agents and in a recently published small randomized double-blind placebo-controlled study, and an expanding body of literature suggests benefit in select patients. Thus, large randomized clinical trial data are not present to support this approach, and guidelines for use of presurgical therapy have not been promulgated. The advent of immunomodulation through checkpoint inhibition represents an exciting horizon for adjuvant and neoadjuvant strategies. The present article reviews the current status and future prospects of adjuvant and neoadjuvant therapy in localized and locally advanced renal cell carcinoma.
MeSH term(s)	Antineoplastic Agents/therapeutic use ; Carcinoma, Renal Cell/pathology ; Carcinoma, Renal Cell/therapy ; Chemotherapy, Adjuvant ; Humans ; Kidney Neoplasms/pathology ; Kidney Neoplasms/therapy ; Neoadjuvant Therapy ; Randomized Controlled Trials as Topic ; Sunitinib/therapeutic use
Chemical Substances	Antineoplastic Agents ; Sunitinib (V99T50803M)
Language	English
Publishing date	2019-04-03
Publishing country	Australia
Document type	Journal Article ; Research Support, Non-U.S. Gov't ; Review
ZDB-ID	1328401-0
ISSN	1442-2042 ; 0919-8172
ISSN (online)	1442-2042
ISSN	0919-8172
DOI	10.1111/iju.13943
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Article ; Online: Robotic partial nephrectomy for clinical T2a renal mass is associated with improved trifecta outcome compared to open partial nephrectomy: a single surgeon comparative analysis.

Ghali, Fady / Elbakry, Amr A / Hamilton, Zachary A / Yim, Kendrick / Nasseri, Ryan / Patel, Sunil / Eldefrawy, Ahmed / Ryan, Stephen / Bradshaw, Aaron W / Meagher, Margaret / Bree, Kelly / Reddy, Madhumitha / Lee, Hak J / Derweesh, Ithaar H

World journal of urology

2019 Volume 38, Issue 5, Page(s) 1113–1122

Abstract: Objective: Utilization of partial nephrectomy (PN) for T2 renal mass is controversial due to concerns regarding burden of morbidity, though most cited data are from open PN (OPN). We compared surgical quality and functional outcomes of RPN and OPN for ... ...

Abstract	Objective: Utilization of partial nephrectomy (PN) for T2 renal mass is controversial due to concerns regarding burden of morbidity, though most cited data are from open PN (OPN). We compared surgical quality and functional outcomes of RPN and OPN for clinical T2a renal masses (cT2aRM). Methods: Retrospective analysis of 150 consecutive patients [RPN 59/OPN 91] who underwent PN from July 2008 to June 2016. Main outcome was achievement of Trifecta [negative surgical margin, no major urologic complications, and ≥90% preservation of estimated glomerular filtration rate (eGFR)]. Multivariable analysis was performed to identify factors of Trifecta attainment. Results: Mean tumor size (RPN 7.9 vs. OPN 8.4 cm, p = 0.139) and median RENAL score (p = 0.361) were similar. No difference was noted for positive margins (RPN 3.4% vs. OPN 1.1%, p = 0.561), ΔeGFR (RPN - 6.2 vs. OPN - 7.8, p = 0.543), and ≥ 90% eGFR recovery (RPN 54.1% vs. OPN 47.2%, p = 0.504). RPN had lower blood loss (p = 0.015), hospital stay (p = 0.013), and Clavien ≥ 3 complications (RPN 5.1% vs. OPN 16.5%, p = 0.041). Trifecta rate was significantly higher in RPN (47.5% vs. 34.0%, p = 0.041). Multivariable analysis demonstrated decreasing RENAL score (OR 1.11, p < 0.001), RPN (OR 1.2, p = 0.013), and decreasing EBL (OR 1.02, p = 0.016) to be associated with Trifecta attainment. Conclusions: RPN provided similar functional and oncologic precision to OPN, while being associated with improvements in major complications, the latter of which was reflected in a higher rate of Trifecta achievement for RPN. RPN may be considered to be a first-line option for select patients with cT2aRM when feasible and safe.
MeSH term(s)	Aged ; Female ; Glomerular Filtration Rate ; Humans ; Kidney/physiology ; Kidney Neoplasms/pathology ; Kidney Neoplasms/surgery ; Male ; Margins of Excision ; Middle Aged ; Neoplasm Staging ; Nephrectomy/methods ; Postoperative Complications/epidemiology ; Retrospective Studies ; Robotic Surgical Procedures ; Treatment Outcome
Language	English
Publishing date	2019-11-08
Publishing country	Germany
Document type	Comparative Study ; Journal Article
ZDB-ID	380333-8
ISSN	1433-8726 ; 0724-4983
ISSN (online)	1433-8726
ISSN	0724-4983
DOI	10.1007/s00345-019-02994-2
Database	MEDical Literature Analysis and Retrieval System OnLINE

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