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The role of thermal ablation in the management of T1b renal masses is not well defined. The purpose of this review is to examine current evidence for cryoablation, radiofrequency ablation, and microwave ablation of T1b renal masses as well as review current AUA and EAU guidelines for thermal ablation of T1b masses. Given the size of these tumors, adjunctive maneuvers are often necessary to ensure patient safety and protect vital adjacent structures.

Introduction Transrectal ultrasound guided prostate biopsy may be performed by operators with various levels of training. Little is known about the impact of training level on biopsy results. We evaluated the effect of training level on the accuracy of transrectal ultrasound guided prostate biopsy findings. Methods We retrospectively reviewed 500 consecutive patients who underwent transrectal ultrasound guided prostate biopsy and subsequent radical prostatectomy. Transrectal ultrasound operators were stratified based on level of training as junior, senior, chief, fellow or staff. Linear regression was performed to analyze the effect of training level on volume estimates. A weighted Kappa statistic evaluated agreement between biopsy and pathological Gleason scores while an adjusted cumulative logistic regression model analyzed the effects of training level. Results A total of 482 patients were included in the final analysis. Transrectal ultrasound guided biopsy was performed by staff in 78 (16%) patients, by fellows in 18 (4%), chief residents in 48 (10%), senior residents in 126 (26%) and junior residents in 212 (44%). There was no significant difference between transrectal ultrasound and radical prostatectomy specimen volume estimates among the training levels. Level of training was not significantly associated with pathological features, including Gleason score, primary Gleason grade, highest single Gleason grade and estimated tumor volume. Study limitations include the retrospective design and the variability among members of the same group. Conclusions Agreement between biopsy and pathological Gleason scores is high for all levels of training. Training level has no impact on prostate volume estimations or the prediction of pathological features.

Introduction The best method for assessing renal function after partial nephrectomy (PN) continues to be a matter of debate. Early studies evaluated kidney function by measuring serum creatinine (sCr) and/or the estimated glomerular filtration rate (eGFR), potentially underestimating the contribution of the contralateral kidney in masking alterations in renal function. Since then, researchers have studied the operated renal unit with the aid of nuclear renal scans (RS). However, taking into consideration the importance of the amount of renal parenchyma spared or sacrificed during PN, many novel methods have been proposed for determining kidney volume before and after PN. This review presents a critical analysis of the literature concerning renal function assessment using eGFR, renal scan and volumetric methods before and after PN. Evidence acquisition The literature review was carried out using the Pubmed database and the keywords "eGFR", "renal scan" and "volumetric assessment" in combination with "partial nephrectomy" or "nephron-sparing surgery". The search was limited to English language articles published between June 2006 and June 2016. Evidence synthesis Of the available formulas, the Chronic Kidney Disease Epidemiology Collaboration and Modification of Diet in Renal Disease equations should be used as they provide the best estimation of GFR. MAG3 RS is the most widely used method in current practice, presenting several distinct advantages. According to studies on volumetric assessment, as a general rule, renal tumors should be removed with resection of a thin rim of healthy parenchyma or by enucleation following the tumor pseudocapsule plane, as a histologic tumor-free resection margin, irrespective of the width of the margin, is sufficient to achieve local control during PN. There are no clear recommendations regarding the best modality to use. Conclusions The use of serum creatinine alone should be avoided. The use of glomerular filtration rate, as estimated by means of available formulas, could be a viable option. If available, a nuclear RS should be adopted, whilst taking into account the limitations of this imaging methodology. Volumetric assessment continues to lack certainty. To date, no single proposed method for volumetric assessment appears to be superior above the others.