RENAL TRANSPLANTATION AND RENOVASCULAR HYPERTENSION
784
Renal Transplantation and Renovascular Hypertension Nephron Sparing Surgery for De Novo Kidney Graft Tumor: Results from a Multicenter National Study X. Tillou, K. Guleryuz, A. Doerfler, H. Bensadoun, D. Chambade, R. Codas, M. Devonec, ne chal, F. Salusto, F. Dugardin, A. Erauso, J. Hubert, G. Karam, L. Salomon, C. Se N. Terrier, M. O. Timsit, R. Thuret, G. Verhoest and F. Kleinclauss; Renal Transplantation Committee of the French Urological Association (CTAFU) Department of Urology, CHU de Caen, Caen, France Am J Transplant 2014; 14: 2120e2125.
Abstract for this article http://dx.doi.org/10.1016/j.juro.2014.12.012 available at http://jurology.com/ Editorial Comment: This study represents the largest clinical series describing the result of nephron sparing surgery for renal allograft tumors. Tumors in renal allografts are rare. There are unique challenges to this type of surgery. Compared to the native kidney, surgery on the renal allograft is often associated with dense adhesion to the retroperitoneum and scar surrounding the vessels, making mobilization and vascular control difficult. Slightly more than 50% of the 79 cases from 32 centers were managed by partial nephrectomy. Mean tumor size was 26 mm. Technical, renal functional and oncologic outcomes were good. Immunosuppression in some patients was modified after partial nephrectomy by eliminating a calcineurin inhibitor or adding a mTOR inhibitor, although optimal immunosuppression cannot be determined by these data. This study reinforces that good results from partial nephrectomy for small tumors in renal allografts can be achieved. David A. Goldfarb, MD
Imaging Re: MR Imaging of Urinary Bladder Cancer for T-Staging: A Review and a Pictorial Essay of Diffusion-Weighted Imaging M. Takeuchi, S. Sasaki, T. Naiki, N. Kawai, K. Kohri, M. Hara and Y. Shibamoto Department of Radiology, Graduate School of Medical Sciences and Medical School, Nagoya City University, Nagoya, Japan J Magn Reson Imaging 2013; 38: 1299e1309.
Abstract for this article http://dx.doi.org/10.1016/j.juro.2014.12.058 available at http://jurology.com/ Editorial Comment: This is a review article on magnetic resonance imaging and bladder cancer with special emphasis on diffusion imaging. The authors discuss tumor stage classification of bladder cancer using T1 and T2 diffusion weighted and dynamic contrast enhanced magnetic resonance imaging. The normal anatomy and abnormal anatomy of the pelvis on diffusion weighted imaging are illustrated. Excellent examples of the T2 diffusion weighted appearance of the stalk of a papillary tumor are well identified and of low signal intensity. Discussion of T1 vs T2, T2 vs T3 and T3 vs T4 staging is nicely outlined and supplemented with images. There is a section on tumor extension into the urethra and prostate. This report is a good review for radiologists and urologists who stage bladder tumors. Cary Siegel, MD
IMAGING
785
Re: Surveillance of Patients with Bladder Cancer following Cystectomy: Yield of CT Urography A. B. Shinagare, C. A. Sadow and S. G. Silverman Division of Abdominal Imaging and Intervention, Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts Abdom Imaging 2013; 38: 1415e1421.
Abstract for this article http://dx.doi.org/10.1016/j.juro.2014.12.059 available at http://jurology.com/ Editorial Comment: The authors evaluated 225 computerized tomographic urograms (CTUs) performed in 105 patients who had undergone cystectomy for bladder cancer. Followup averaged 63 months (range 1 to 234). The authors specifically looked for findings related to the cystectomy, local recurrence, metastatic disease and upper tract urothelial tumors. The majority of patients (66%) had CTU findings related to the surgery, including hydronephrosis and parastomal hernia. Visceral metastases and lymph node metastases were found in 15% and 12% of patients, respectively. Upper tract urothelial tumors were detected in 3% of patients. This series supports the use of CTU for followup of patients with bladder cancer. Limitations of the study are that the followup interval was variable and the overall sample size was small for assessment of metachronous upper tract tumors (only 3 patients had this finding). In this study pelvic recurrence was identified in a single patient at 39 months, lymph node metastases were detected after a mean of 11 months and distant metastatic disease was detected after a mean of 16.5 months. Metachronous upper tract tumors developed after a median of 43 months. This study is important in quantifying the frequency and time course of cystectomy complications, local/regional recurrence, metastatic disease and metachronous upper tract tumors. Early identification of complications of urinary diversion, including leak, stone, stricture and parastomal hernia, is important. Early identification of metastatic disease may hasten the initiation of chemotherapy and improve prognosis. This article serves as an excellent resource for radiologists and urologists caring for patients undergoing cystectomy. Cary Siegel, MD
784
Renal Transplantation and Renovascular Hypertension Nephron Sparing Surgery for De Novo Kidney Graft Tumor: Results from a Multicenter National Study X. Tillou, K. Guleryuz, A. Doerfler, H. Bensadoun, D. Chambade, R. Codas, M. Devonec, ne chal, F. Salusto, F. Dugardin, A. Erauso, J. Hubert, G. Karam, L. Salomon, C. Se N. Terrier, M. O. Timsit, R. Thuret, G. Verhoest and F. Kleinclauss; Renal Transplantation Committee of the French Urological Association (CTAFU) Department of Urology, CHU de Caen, Caen, France Am J Transplant 2014; 14: 2120e2125.
Abstract for this article http://dx.doi.org/10.1016/j.juro.2014.12.012 available at http://jurology.com/ Editorial Comment: This study represents the largest clinical series describing the result of nephron sparing surgery for renal allograft tumors. Tumors in renal allografts are rare. There are unique challenges to this type of surgery. Compared to the native kidney, surgery on the renal allograft is often associated with dense adhesion to the retroperitoneum and scar surrounding the vessels, making mobilization and vascular control difficult. Slightly more than 50% of the 79 cases from 32 centers were managed by partial nephrectomy. Mean tumor size was 26 mm. Technical, renal functional and oncologic outcomes were good. Immunosuppression in some patients was modified after partial nephrectomy by eliminating a calcineurin inhibitor or adding a mTOR inhibitor, although optimal immunosuppression cannot be determined by these data. This study reinforces that good results from partial nephrectomy for small tumors in renal allografts can be achieved. David A. Goldfarb, MD
Imaging Re: MR Imaging of Urinary Bladder Cancer for T-Staging: A Review and a Pictorial Essay of Diffusion-Weighted Imaging M. Takeuchi, S. Sasaki, T. Naiki, N. Kawai, K. Kohri, M. Hara and Y. Shibamoto Department of Radiology, Graduate School of Medical Sciences and Medical School, Nagoya City University, Nagoya, Japan J Magn Reson Imaging 2013; 38: 1299e1309.
Abstract for this article http://dx.doi.org/10.1016/j.juro.2014.12.058 available at http://jurology.com/ Editorial Comment: This is a review article on magnetic resonance imaging and bladder cancer with special emphasis on diffusion imaging. The authors discuss tumor stage classification of bladder cancer using T1 and T2 diffusion weighted and dynamic contrast enhanced magnetic resonance imaging. The normal anatomy and abnormal anatomy of the pelvis on diffusion weighted imaging are illustrated. Excellent examples of the T2 diffusion weighted appearance of the stalk of a papillary tumor are well identified and of low signal intensity. Discussion of T1 vs T2, T2 vs T3 and T3 vs T4 staging is nicely outlined and supplemented with images. There is a section on tumor extension into the urethra and prostate. This report is a good review for radiologists and urologists who stage bladder tumors. Cary Siegel, MD
IMAGING
785
Re: Surveillance of Patients with Bladder Cancer following Cystectomy: Yield of CT Urography A. B. Shinagare, C. A. Sadow and S. G. Silverman Division of Abdominal Imaging and Intervention, Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts Abdom Imaging 2013; 38: 1415e1421.
Abstract for this article http://dx.doi.org/10.1016/j.juro.2014.12.059 available at http://jurology.com/ Editorial Comment: The authors evaluated 225 computerized tomographic urograms (CTUs) performed in 105 patients who had undergone cystectomy for bladder cancer. Followup averaged 63 months (range 1 to 234). The authors specifically looked for findings related to the cystectomy, local recurrence, metastatic disease and upper tract urothelial tumors. The majority of patients (66%) had CTU findings related to the surgery, including hydronephrosis and parastomal hernia. Visceral metastases and lymph node metastases were found in 15% and 12% of patients, respectively. Upper tract urothelial tumors were detected in 3% of patients. This series supports the use of CTU for followup of patients with bladder cancer. Limitations of the study are that the followup interval was variable and the overall sample size was small for assessment of metachronous upper tract tumors (only 3 patients had this finding). In this study pelvic recurrence was identified in a single patient at 39 months, lymph node metastases were detected after a mean of 11 months and distant metastatic disease was detected after a mean of 16.5 months. Metachronous upper tract tumors developed after a median of 43 months. This study is important in quantifying the frequency and time course of cystectomy complications, local/regional recurrence, metastatic disease and metachronous upper tract tumors. Early identification of complications of urinary diversion, including leak, stone, stricture and parastomal hernia, is important. Early identification of metastatic disease may hasten the initiation of chemotherapy and improve prognosis. This article serves as an excellent resource for radiologists and urologists caring for patients undergoing cystectomy. Cary Siegel, MD
