4 The risk of postoperative fever significantly increased for patients with a positive preoperative urine culture, diabetes, staghorn calculus, or preoperatively placed nephrostomy tube.5 For the entire cohort, the stone-free rate was 83%, and postoperative computed tomography (CT) scan was more VE-822 manufacturer accurate than radiography or ultrasound in evaluating residual fragments.6 Small Renal Masses As with prostate cancer, there is increasing concern about overdiagnosis and overtreatment of small renal masses (SRMs). Although specific imaging features have been associated Inhibitors,research,lifescience,medical with more favorable prognosis (ie, slow growth rate,

smaller size, exophytic, presence of an angular interface on magnetic resonance imaging [MRI]), there remain significant limitations in our ability to assess tumor aggressiveness noninvasively and determine Inhibitors,research,lifescience,medical the need for intervention. A panel of experts

on the treatment of SRMs was convened to present the most recent data and recommendations. The new American Urological Association guidelines for the management of SRMs were reviewed, providing several options based on tumor size and comorbidities.7 On one end of the spectrum is active surveillance (AS). Data presented from several contemporary series suggest that for tumors < 3 cm, metastasis occurs in approximately 1% to 2% of patients over a 3- to 5-year interval.8 Given approximately 99% cancer-specific survival Inhibitors,research,lifescience,medical during this period, AS represents a viable option, particularly for patients with

Inhibitors,research,lifescience,medical significant comorbidities. Alternative management options include percutaneous or laparoscopic cryotherapy and radiofrequency ablation, although there are limited data on their long-term survival outcomes. Of these techniques, cryotherapy may be preferred due to the presence of skip lesions in some series Inhibitors,research,lifescience,medical of radiofrequency ablation. Overall, local recurrence-free survival rates with these ablative techniques appear inferior to those obtained with extirpative surgery, although rates of metastasis are comparable. There is evidence that partial nephrectomy continues to be underutilized as compared with radical nephrectomy for SRMs.9 This is unfortunate given the adverse sequelae of renal Dipeptidyl peptidase insufficiency and the importance of nephron sparing. On the other hand, the use of robot-assisted partial nephrectomy (RAPN) has dramatically increased. A study of RAPN across 25 institutions encompassing 33 surgeons of varying experience levels demonstrated acceptable perioperative results. For 1269 patients with a mean tumor size of 3.1 cm, mean operative time was 203 minutes, warm ischemia time was 25.2 minutes, estimated blood loss was 184 mL, positive margin rate was 4%, and the overall complication rate was 15.7%.10 Finally, there was discussion about an increasing role for renal mass biopsy in guiding therapy, and the importance of using a coaxial technique for core biopsy instead of fine needle aspiration.