Search

Objective: To assess the correlation between the general (gender, age, and maximum tumor size) and 3D morphotopometric features of the renal tumor node, following the MSCT data post-processing, and the tumor histological structure; to propose an equation allowing for kidney malignancy assessment based on general and morphometric features. Materials and methods: In total, 304 patients with unilateral solitary renal neoplasms underwent laparoscopic (retroperitoneoscopic) or robotic partial or radical nephrectomy. Before the procedure, kidney contrast-enhanced MSCT followed by the tumor 3D-modeling was performed. 3D model of the kidney tumor, and its morphotopometric features, and histological structure were analyzed. The morphotopometric ones include the side of the lesion, location by segments, the surface where the tumor, the depth of the tumor invasion into the kidney, and the shape of tumor. Results: Out of 304 patients, 254 (83.6%) had malignant kidney tumors and 50 (16.4%) benign kidney tumors. In total, 231 patients, out of 254 (90.9%) were assessed for the degree of malignant tumor differentiation. Malignant tumors were more frequent in men than in women (p < 0.001). Mushroom-shaped tumors were the most common shapes among benign renal masses (35.2%). The most common malignant kidney tumors had spherical with a partially uneven surface (27.6%), multinodular (tuberous (27.2%)), and spherical with a conical base (24.8%) shapes. Logistic regression model enabled the development of prognostic equation for tumor malignancy prediction ("low" or "high"). The univariate analysis revealed the correlation only between high differentiation (G1) and a spherical tumor with a conical base (p = 0.029). Conclusion: The resulting logistic model, based on the analysis of such predictors as gender and form of kidney lesions, demonstrated a large share (87.6%) of correct predictions of the kidney tumor malignancy. [ABSTRACT FROM AUTHOR]

Introduction: We aimed to evaluate the effect of eleven11th rib resection.on the perioperative period TRIFECTA criteria in patients who underwent retroperitoneal partial nephrectomy (PN) with the diagnosis of upper pole kidney tumors. Materials and methods: We conducted a retrospective analysis of the data of the patients who underwent Open PN for upper pole renal masses between 2018 and 2023. The patients were divided into two groups: PN with rib resection and PN without rib resection. The demographic characteristics, tumor sizes, PADUA scores, warm–cold renal ischemia times, mass excision and tumor bed suturing times, histopathological tumor type and surgical margin positivity of the patients were examined. Both groups were evaluated comparatively based on this data. Results: The renal nephrometry scores of the two groups were similar. The total renal ischemia time was significantly shorter in the patients who underwent a rib resection than in those who did not (p < 0.001). Both the tumor excision and tumor bed suturing times were significantly shorter in the group that underwent a rib resection than in the group that did not (p < 0.001). The Clavien–Dindo complication grades were statistically similar between the two groups. Conclusion: Complex in nature and high–risk renal masses located in the upper pole of the kidney, partial nephrectomy performed with an 11th rib resection can be considered a reliable surgical option with a shorter ischemia time, supporting the preservation of long-term renal function. [ABSTRACT FROM AUTHOR]

Atrophic kidney-like lesion (AKLL) is a rare kidney lesion, which was recently suggested by the Genitourinary Pathology Society as a provisional entity. As of now, 16 examples of AKLL have been described in the literature. Here we report a new tumor which shows similar clinicopathologic characteristics with those previously reported in AKLL. Immunohistochemical (IHC) studies in the current lesion identified a biphasic staining pattern consisting of a mixture of WT1+/KRT7-/PAX8- large dilated cysts and WT-/KRT7+/PAX8+ small atrophic cysts. Histomorphologic features of AKLL overlap with several neoplastic and non-neoplastic entities which can lead to mischaracterization. Awareness of the differentiating features is likely important when evaluating these lesions. [ABSTRACT FROM AUTHOR]

Radical or partial nephrectomy, commonly used for the treatment of kidney tumors, is a surgical procedure with a risk of high blood loss. The primary aim of this study is to quantify blood loss and elucidate the redistribution of blood flux and pressure between the two kidneys and the abdominal aorta during renal resection. We have developed a robust research methodology that introduces a new lumped-parameter mathematical model, specifically focusing on the vasculature of both kidneys using a non-Newtonian Carreau fluid. This model, a first-order approximation, accounts for the variation in the total impedance of the vasculature when various vessels are severed in the diseased kidney (assumed to be the left in this work). The model offers near real-time estimations of the flow–pressure redistribution within the vascular network of the two kidneys and the downstream aorta for several radical or partial nephrectomy scenarios. Notably, our findings indicate that the downstream aorta receives an approximately 1.27 times higher percentage of the redistributed flow from the diseased kidney compared to that received by the healthy kidney, in nearly all examined cases. The implications of this study are significant, as they can inform the development of surgical protocols to minimize blood loss and can assist surgeons in evaluating the adequacy of the remaining kidney vasculature. [ABSTRACT FROM AUTHOR]

This report recounts the diagnostic workup of a pediatric female who presented with hematuria secondary to a large renal mass visualized on abdominal imaging. Histologic assessment and subsequent immunohistochemistry studies were performed. Intense, unequivocal immunohistochemical expression of TFE3 and alpha-methylacyl-CoA-racemase with corresponding negativity for carbonic anhydrase IX, along with highly distinctive clinical, radiologic, gross, and microscopic findings confirmed the diagnosis of a renal cell carcinoma with TFE3 gene rearrangement – the first ever reported case in the Philippines. This case highlights the vital role and significant diagnostic impact of reliable, affordable and accessible immunohistochemistry studies in low-resource settings where molecular modalities for evaluating rare diseases are largely unavailable. Recognition of distinctive morphologic, immunohistochemical, and cytogenetic features in childhood and adolescent renal malignancies allows for the timely institution of therapeutic interventions for this aggressive entity. [ABSTRACT FROM AUTHOR]

Disease prediction is greatly challenged by the scarcity of datasets and privacy concerns associated with real medical data. An approach that stands out to circumvent this hurdle is the use of synthetic data generated using Generative Adversarial Networks (GANs). GANs can increase data volume while generating synthetic datasets that have no direct link to personal information. This study pioneers the use of GANs to create synthetic datasets and datasets augmented using traditional augmentation techniques for our binary classification task. The primary aim of this research was to evaluate the performance of our novel Conditional Deep Convolutional Neural Network (C-DCNN) model in classifying brain tumors by leveraging these augmented and synthetic datasets. We utilized advanced GAN models, including Conditional Deep Convolutional Generative Adversarial Network (DCGAN), to produce synthetic data that retained essential characteristics of the original datasets while ensuring privacy protection. Our C-DCNN model was trained on both augmented and synthetic datasets, and its performance was benchmarked against state-of-the-art models such as ResNet50, VGG16, VGG19, and InceptionV3. The evaluation metrics demonstrated that our C-DCNN model achieved accuracy, precision, recall, and F1 scores of 99% on both synthetic and augmented images, outperforming the comparative models. The findings of this study highlight the potential of using GAN-generated synthetic data in enhancing the training of machine learning models for medical image classification, particularly in scenarios with limited data available. This approach not only improves model accuracy but also addresses privacy concerns, making it a viable solution for real-world clinical applications in disease prediction and diagnosis. [ABSTRACT FROM AUTHOR]

Early intervention in tumors can greatly improve human survival rates. With the development of deep learning technology, automatic image segmentation has taken a prominent role in the field of medical image analysis. Manually segmenting kidneys on CT images is a tedious task, and due to the diversity of these images and varying technical skills of professionals, segmentation results can be inconsistent. To address this problem, a novel ASD-Net network is proposed in this paper for kidney and kidney tumor segmentation tasks. First, the proposed network employs newly designed Adaptive Spatial-channel Convolution Optimization (ASCO) blocks to capture anisotropic information in the images. Then, other newly designed blocks, i.e., Dense Dilated Enhancement Convolution (DDEC) blocks, are utilized to enhance feature propagation and reuse it across the network, thereby improving its segmentation accuracy. To allow the network to segment complex and small kidney tumors more effectively, the Atrous Spatial Pyramid Pooling (ASPP) module is incorporated in its middle layer. With its generalized pyramid feature, this module enables the network to better capture and understand context information at various scales within the images. In addition to this, the concurrent spatial and channel squeeze & excitation (scSE) attention mechanism is adopted to better comprehend and manage context information in the images. Additional encoding layers are also added to the base (U-Net) and connected to the original encoding layer through skip connections. The resultant enhanced U-Net structure allows for better extraction and merging of high-level and low-level features, further boosting the network's ability to restore segmentation details. In addition, the combined Binary Cross Entropy (BCE)-Dice loss is utilized as the network's loss function. Experiments, conducted on the KiTS19 dataset, demonstrate that the proposed ASD-Net network outperforms the existing segmentation networks according to all evaluation metrics used, except for recall in the case of kidney tumor segmentation, where it takes the second place after Attention-UNet. [ABSTRACT FROM AUTHOR]

Accurate segmentation of kidney tumors in CT images is very important in the diagnosis of kidney cancer. Automatic semantic segmentation of the kidney tumor has shown promising results towards developing advance surgical planning techniques in the treatment of kidney tumor. However, the relatively small size of kidney tumor volume in comparison to the overall kidney volume, and its irregular distribution and shape makes it difficult to accurately segment the tumors. In addressing this issue, we proposed a coarse to fine segmentation which leverages on transfer learning using SE-ResNeXt model for the initial segmentation and ResNet and Feature Pyramid Network for the final segmentation. The processes are related and the output of the initial results was used for the final training. We trained and evaluated our method on the KITS19 dataset and achieved a dice score of 0.7388 and Jaccard score 0.7321 for the final segmentation demonstrating promising results when compared to other approaches.

Aim. To establish the criteria of selection for extracorporeal partial nephrectomy (EPN) among patients with malignant tumors involving renal parenchyma. Materials and methods. The study included data of 34 patients undergone 36 EPNs (2 [5.8%] bilateral) for absolute indications in 32 (94.2%) and relative indications – in 2 (5.8%) cases. The median age of the patients was 49 (31–61) years, and 24 (70.6%) were males. 33 (97.1%) patients were diagnosed with renal cell carcinoma, 1 (2.9%) – with primary retroperitoneal leiomyosarcoma involving a solitary kidney. No regional metastases were detected in any patients; 2 patients were diagnosed with solitary metastases in the adrenal gland. In all patients EPN was performed (2 [5.8%] – with adrenalectomy); the surgery was completed in 35 (97.2%) patients. No additional anti-tumor treatment was administered in any patient. The median follow-up was 65.6 months. Results. The median surgery time was 674 (360–870) min, and the median blood loss was 2100 (500–7000) mL. The rate of postoperative complications of EPN was 82.9% (30/35), including 48.6% (17/35) of grade 1–4 and 8.6% (3/35) of grade 5 complications. Severe acute kidney injury was reported in 68.0% (25/33) of patients with completed EPN. Renal replacement therapy was required in 45.5% (15/33) of cases. The rate of postoperative autograft loss was 17.1% (7/35). One patient received intermittent hemodialysis (7 years after EPN). 5-year overall survival of 33 patients with completed EPN was 64.4%; the 5-year specific and disease-free survival of patients with renal cell carcinoma was 85.5% and 54.3%, respectively, and 5-year hemodialysis-free survival in patients discharged with autograft was 76.2%. Conclusion. EPN is indicated only for carefully selected patients with absolute indications for organ-preserving treatment, with massive multifocal centrally located malignant tumors in the renal parenchyma, the radical removal of which in situ is technically impossible.

Ewing's sarcoma of the kidney is a rare tumor. Although renal carcinomas are known to involve the inferior cava, extension of the tumor up to the right atrium is not common. In the majority of cases when the tumor extends into the infrahepatic part of the inferior vena cava, it can be removed from the abdominal approach. Few patients require the use of cardiopulmonary bypass for removal of the tumor in the inferior vena cava and right atrium. The management of patients requiring resection of kidney tumors and right atrial mass is more complicated and requires a team approach consisting of oncosurgeons, cardiac surgeons, and cardiac anesthetists. The resection of the kidney tumor with a mass in the right atrium is usually done concomitantly. The cardiopulmonary bypass cannulation strategy needs to be modified in such cases. [ABSTRACT FROM AUTHOR]

The precise classification of kidneys and kidney tumors is of great guiding significance for the diagnosis and surgical planning of clinical doctors. Artificial segmentation of kidneys and renal tumors not only increases the workload of doctors, but also has a certain degree of subjectivity. Due to the varying morphology and pathological characteristics of various kidney tumors, conventional imaging analysis methods have certain limitations in their application. This study aims to propose a novel optical imaging device based on deep learning to achieve better results in kidney tumor image segmentation and recognition. The study collected a batch of image data on kidney tumors and trained the data using deep learning algorithms. After many experiments and optimization, a model with excellent performance in renal tumor segmentation and recognition was obtained. Compared with several existing methods, the method proposed in this paper has better segmentation accuracy for kidney tumors. This can not only avoid mutual interference between the network and the resolution network, but also improve the recognition efficiency between the two networks. In addition, the system can also provide reliable data feedback for clinical doctors, helping them continuously correct problems in subsequent visual examinations, thereby achieving higher diagnostic accuracy. The experimental results show that the neural network is effective in image segmentation and quantitative analysis, and can be applied in clinical practice. [ABSTRACT FROM AUTHOR]

Radical or partial nephrectomy, commonly used for the treatment of kidney tumors, is a surgical procedure with a risk of high blood loss. The primary aim of this study is to quantify blood loss and elucidate the redistribution of blood flux and pressure between the two kidneys and the abdominal aorta during renal resection. We have developed a robust research methodology that introduces a new lumped-parameter mathematical model, specifically focusing on the vasculature of both kidneys using a non-Newtonian Carreau fluid. This model, a first-order approximation, accounts for the variation in the total impedance of the vasculature when various vessels are severed in the diseased kidney (assumed to be the left in this work). The model offers near real-time estimations of the flow–pressure redistribution within the vascular network of the two kidneys and the downstream aorta for several radical or partial nephrectomy scenarios. Notably, our findings indicate that the downstream aorta receives an approximately 1.27 times higher percentage of the redistributed flow from the diseased kidney compared to that received by the healthy kidney, in nearly all examined cases. The implications of this study are significant, as they can inform the development of surgical protocols to minimize blood loss and can assist surgeons in evaluating the adequacy of the remaining kidney vasculature.

Purpose: Wilms' tumor (WT) is a rare kidney cancer that primarily affects children. Exosomes are extracellular vesicles that cargo nucleic acids, proteins,etc. for cellular communication. Long non-coding RNAs (lncRNAs) have utility as biomarkers for cancer diagnosis, prognosis, and disease monitoring. We hypothesize that expression of lncRNA, metastasis-associated lung adenocarcinoma transcript-1(MALAT1), is dysregulated and possibly trafficked within exosomes to influence the tissue microenvironment for metastasis and recurrence of WT. Methods: We investigated the expression of MALAT1 in thirty WT samples by qPCR. Exosomes were isolated using a precipitated and affinity-binding-based kit, and characterized using TEM, NTA, and DLS. Results: Mean number of exosomes was 9.01×108/mL in primary culture, 1.64×108/mL in urine, and 4.65×108/plasma:400µl. Average yield of total RNA was 1.28µg (primary-culture supernatant:1ml), 1.47µg (Urine:1ml), 1.65µg (Plasma:400 µL). We quantified MALAT1 in exosomes derived from these sources in patients of WT. Expression of MALAT1 was significantly downregulated (p=0.008) in WT samples. Conclusion: This is the first study that demonstrated the presence of lncRNA MALAT1 in various invasive and non-invasive samples of patients with WT(primary tissue culture, urine, and plasma samples). [ABSTRACT FROM AUTHOR]

Simple Summary: Renal cell cancer, constituting the predominant type of kidney malignancy, exhibits a global annual incidence increase of 2%. In the management of clinical T1 renal tumors, the recommended surgical approach is partial nephrectomy (PN). The primary objective of this procedure is the preservation of nephrons, thereby mitigating the risk of enduring kidney dysfunction and maintaining comparable oncological outcomes when contrasted with radical nephrectomy. Initially performed as an open surgery, PN has undergone significant evolution, with minimally invasive techniques, particularly robot-assisted ones, garnering recognition. Nonetheless, despite the inherent advantages, partial nephrectomy presents specific challenges, notably an elevated likelihood of incomplete tumor excision and positive surgical margins, which may have implications for cancer-specific outcomes. To address these challenges, the utilization of near-infrared fluorescence technology, involving the intravenous administration of indocyanine green (ICG), has been proposed. ICG, a water-soluble compound that binds to plasma albumin, emits near-infrared light, enabling the visualization of kidney vasculature and renal tumors. Background: We aimed to analyze the influence of near-infrared fluorescence (NIRF) using indocyanine green (ICG) with standard robot-assisted partial nephrectomy (RAPN) in patients with a kidney tumor (KT). Methods: We performed a literature search on 12 September 2023 through PubMed, EMBASE, and Scopus. The analysis included observational studies that examined the perioperative and long-term outcomes of patients with a KT who underwent RAPN with NIRF. Results: Overall, eight prospective studies, involving 535 patients, were eligible for this meta-analysis, with 212 participants in the ICG group and 323 in the No ICG group. For warm ischemia time, the ICG group showed a lower duration (weighted Mean difference (WMD) = −2.05, 95% confidence interval (CI) = −3.30–−0.80, p = 0.011). The postoperative eGFR also favored the ICG group (WMD = 7.67, 95% CI = 2.88–12.46, p = 0.002). No difference emerged for the other perioperative outcomes between the two groups. In terms of oncological radicality, the positive surgical margins and tumor recurrence rates were similar among the two groups. Conclusions: Our meta-analysis showed that NIRF with ICG during RAPN yields a favorable impact on functional outcomes, whereas it exerts no such influence on oncological aspects. Therefore, NIRF should be adopted when preserving nephron function is a paramount concern. [ABSTRACT FROM AUTHOR]

In 2021, approximately 51% of patients diagnosed with kidney tumors underwent surgical resections. One possible way to reduce complications from surgery is to minimise the associated blood loss, which, in the case of partial nephrectomy, is caused by the inadequate repair of branching arteries within the kidney cut during the tumor resection. The kidney vasculature is particularly complicated in nature, consisting of various interconnecting blood vessels and numerous bifurcation, trifurcation, tetrafurcation, and pentafurcation points. In this study, we present a mathematical lumped-parameter model of a whole kidney, assuming a non-Newtonian Carreau fluid, as a first approximation of estimating the blood loss arising from the cutting of single or multiple vessels. It shows that severing one or more blood vessels from the kidney vasculature results in a redistribution of the blood flow rates and pressures to the unaltered section of the kidney. The model can account for the change in the total impedance of the vascular network and considers a variety of multiple cuts. Calculating the blood loss for numerous combinations of arterial cuts allows us to identify the appropriate surgical protocols required to minimise blood loss during partial nephrectomy as well as enhance our understanding of perfusion and account for the possibility of cellular necrosis. This model may help renal surgeons during partial organ resection in assessing whether the remaining vascularisation is sufficient to support organ viability. [ABSTRACT FROM AUTHOR]

(1) Background: Computed tomography (CT) imaging challenges in diagnosing renal cell carcinoma (RCC) include distinguishing malignant from benign tissues and determining the likely subtype. The goal is to show the algorithm's ability to improve renal cell carcinoma identification and treatment, improving patient outcomes. (2) Methods: This study uses the European Deep-Health toolkit's Convolutional Neural Network with ECVL, (European Computer Vision Library), and EDDL, (European Distributed Deep Learning Library). Image segmentation utilized U-net architecture and classification with resnet101. The model's clinical efficiency was assessed utilizing kidney, tumor, Dice score, and renal cell carcinoma categorization quality. (3) Results: The raw dataset contains 457 healthy right kidneys, 456 healthy left kidneys, 76 pathological right kidneys, and 84 pathological left kidneys. Preparing raw data for analysis was crucial to algorithm implementation. Kidney segmentation performance was 0.84, and tumor segmentation mean Dice score was 0.675 for the suggested model. Renal cell carcinoma classification was 0.885 accurate. (4) Conclusion and key findings: The present study focused on analyzing data from both healthy patients and diseased renal patients, with a particular emphasis on data processing. The method achieved a kidney segmentation accuracy of 0.84 and mean Dice scores of 0.675 for tumor segmentation. The system performed well in classifying renal cell carcinoma, achieving an accuracy of 0.885, results which indicates that the technique has the potential to improve the diagnosis of kidney pathology. [ABSTRACT FROM AUTHOR]

A 53-year-old male patient presented with an incidental finding of a left kidney mass after being evaluated for elevated serum creatinine without having any symptoms. The left kidney mass was confirmed by ultrasound, computed tomography 'CT' scan and magnetic resonance imaging 'MRI'. A left radical nephrectomy was done, and histopathology confirmed the presence of intrarenal neurofibroma with no evidence of malignancy. [ABSTRACT FROM AUTHOR]

Cystic nephroma (CN) is a rare, asymptomatic, benign kidney tumor. Clinically and radiologically, CN is difficult to distinguish from malignant tumors such as cystic partially differentiated nephroblastoma and cystic Wilms tumor, and the definitive diagnosis is made by histopathological examination. The effective method of treatment is removal of the tumor. Depending on the location and size of the mass, total nephrectomy or nephron-sparing surgery are the treatment options. DICER1 gene mutation is frequently seen in bilateral cases, and DICER1 gene mutation was also positive in our fourteen-month-old male patient. Since the gene has a predisposition to malignancy. We aimed to present our approach with the literature [ABSTRACT FROM AUTHOR]

The incidence of renal cell cancer (RCC) is low in individuals aged less than 40 years; however several studies have shown this increasing trend over the years. Hereditary syndromes are associated with RCC and are more frequently observed in early-onset cases. In this study, we investigated the characteristics of the patients, aged less than 40 years, who were operated for a renal mass with the suspicion of RCC. We analyzed patients aged

Objective: To report long-term functional and oncological outcomes of OPN Methods: We enrolled 182 patients who underwent consecutive OPN with a diagnosis of kidney tumor in our clinic between April 2002 and February 2020 and were selected from our prospective OPN database. Preoperative demographic and clinical characteristics, intraoperative and pathological results, and patients' postoperative functional and oncological follow-up data were retrospectively analyzed. Overall survival (OS) and disease- free survival (DFS) were evaluated using Kaplan-Meier survival analysis. The time-dependent variation between preoperative and postoperative functional results was statistically analyzed and presented in a graph. Results and limitations: The mean age was 54.4 ± 10.8 yr, and the median age-adjusted Charlson comorbidity index (ACCI) was 1 (interquartile range [IQR] 0-1). The mean tumor size was 3.1 ± 1.2 cm, and the median RENAL score was 6 (IQR 5-8). The most common malign histopathological subtype was clear cell carcinoma with 76.6%, and five cases (3.4%) had positive surgical margins (PSMs). The most common surgical techniques were the retroperitoneal approach (98.9%) and cold ischemia (88.5%). Estimated glomerular filtration rate (eGFR) preservation was 92% (80.8-99.3, IQR), which translates to 32% chronic kidney disease (CKD) upstaging. Acute kidney injury (AKI) was detected in 27 (14.8%) patients according to RIFLE criteria. The intraoperative complication rate was 5.5%, and the postoperative overall complication rate (Clavien-Dindo 1-5) was 30.2%. Major complications (Clavien-Dindo 3-5) were observed in 13 (7.1%) patients. The median oncological follow-up was 42 mo (21.3- 84.6, IQR), and the 5- and 10-yr OS were 90.1% and 78.6%, 5 and 10-yr DFS were 99.4% and 92.1%, respectively. No local recurrence was observed in 5 (3.4%) patients with PSMs; only one had distant metastasis in the 8th postoperative month. The retrospective design, the small number of patients who underwent PN based on mandatory indication, and one type of surgical approach may limit the generalizability of our findings. Conclusions: This study confirms excellent long-term oncologic and functional outcomes after OPN in a cohort of patients selected from a single institution. In light of the information provided by the literature and our study, our recommendation is to push the limits of PN under every technically feasible condition in the treatment of kidney tumors to protect the kidney reserve and achieve near-perfect oncological results.

AbstractPurpose To report procedural data and outcomes of a novel image guidance technique, CT renal arteriography (CTRA), performed to target and ablate small intraparenchymal renal tumors.Materials and methods We retrospectively analyzed data of 2 patients undergoing CTRA-guided ablation for 3 renal intraparenchymal tumors, from February to March 2023. We previously evaluated tumor visibility with US/CEUS, and in all cases conspicuity was poor, whereas contrast-enhanced CT (CECT) clearly depicted all hypervascular nodules. Our primary endpoint was CTRA-guidance feasibility for renal ablation, defined as the precise probe deployment inside the target tumor. The secondary endpoint was CTRA-guided ablation technical success, intended as the inclusion of the whole tumor inside the necrotic volume, with 5 mm safety margins. RENAL scores, complications, procedural time, dose length product (DLP), serum creatinine variation and hospital stay length were also recorded.Results A confident deployment of the probe tip inside the nodule was accomplished in all 3 cases, with a 100% of correct targeting. We observed immediate technical success after all 3 ablations. The 3 nodules had a RENAL score

The incidence of renal cell cancer (RCC) is low in individuals aged less than 40 years; however several studies have shown this increasing trend over the years. Hereditary syndromes are associated with RCC and are more frequently observed in early-onset cases. In this study, we investigated the characteristics of the patients, aged less than 40 years, who were operated for a renal mass with the suspicion of RCC. We analyzed patients aged <40 years who underwent partial or radical nephrectomy between January 2012 and December 2022. A total of 618 patients underwent partial or radical nephrectomy and 60 (9.7%) patients were aged <40 years. A total of 62 renal masses were resected. The median age of the patients was 34 (31.75–38) years. RCC was detected in 50 (80.6%) lesions, while 12 (19.4%) lesions were benign. The most commonly observed benign tumors were oncocytoma and multicystic nephroma. Low-stage RCC (stage 1) was detected in 78% of patients. Recurrence was observed in two patients and both had von Hippel–Landau gene mutation. During follow-up, two patients were found to have lung metastasis, while another patient had bone metastasis. Three patients died during the follow-up period. Disease free survival rate was 89.58% and cancer specific survival rate was 93.88%. The incidences of kidney cancer in young adults are increasing; therefore, early discovery and the diagnosis are important. Further research is required to gain a better understanding. [ABSTRACT FROM AUTHOR]

IntroductionThe American Urological Association (AUA) and the European Association of Urology (EAU) currently recommend partial nephrectomy (PN) over ablation for cT1b lesions. However, recent series have shown comparable outcomes for cryoablation (CA) when compared to PN, making it an appealing alternative for a select group of patients. The objective of this manuscript is to assess treatment outcomes and complications of CA for cT1b lesions. MethodsUsing Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, a comprehensive search was done on MEDLINE and Cochrane Library electronic databases identifying studies that reported on outcomes and complications of CA for kidney tumors. Inclusion criteria included cT1b lesions between 4 cm and 7 cm, excluding treatment of other sizes. ResultsA total of 347 patients with cT1b lesions identified on imaging underwent percutaneous or laparoscopic CA. The average age was > 65 years, the median size of lesions and RENAL score ranged between 4.3–4.8 cm and 8–9, respectively. The majority of patients had a Charlson comorbidity index (CCI) of 2, and median follow-up ranged between 13 months and 95 months. Across all the series, primary and secondary success rates were between 84%–98% and 92%–98%, respectively. The local recurrence ranged from 2.8% to 27%. For patients with documented RCC on biopsy, the 5-year overall survival (OS), cancer-specific survival (CSS), recurrence-free survival (RFS), and metastasis-free survival (MFS) ranged from 56%–91%, 85%–100%, 70%–96.4%, and 90%–96%, respectively. The major complication rate (Clavien-Dindo III-V) was low, at 6.2%. ConclusionWith promising survival outcomes and low complication rates perioperatively, CA is acceptable in a select group of patients with T1b renal tumors, including those who are older, have multiple comorbidities, or have relative or absolute contraindication to surgery.

IntroductionKidney tumors are common cancer in advanced age, and providing early detection is crucial. Medical imaging and deep learning methods are increasingly attractive for identifying and segmenting kidney tumors. Convolutional neural networks have successfully classified and segmented images, enabling clinicians to recognize and segment tumors effectively. CT scans of kidneys aid in tumor assessment and morphology study, using semantic segmentation techniques for pixel-level identification of kidney and surrounding anatomy. Accurate diagnostic procedures are crucial for early detection of kidney cancer.MethodsThis paper proposes an EfficientNet model for complex segmentation by linking the encoder stage EfficientNet with U-Net. This model represents a more successful system with improved encoder and decoder features. The Intersection over Union (IoU) metric quantifies model performance.Results and DiscussionThe EfficientNet models showed high IoU_Scores for background, kidney, and tumor segmentation, with mean IoU_Scores ranging from 0.976 for B0 to 0.980 for B4. B7 received the highest IoU_Score for segmenting kidneys, while B4 received the highest for segmenting tumors. The study utilizes the KiTS19 dataset for contrast-enhanced CT images. Using Semantic segmentation for EfficientNet Family U-Net Models, our method proved even more reliable and will aid doctors in accurate tumor detection and image classification for early diagnosis.

To evaluate the cost-effectiveness of robotic-assisted surgery compared to open surgery in the context of partial nephrectomy for small kidney tumor management. This is a retrospective study using data from 395 patients operated on by either robot-assisted surgery (RAPN) or by open partial nephrectomy (OPN); one hospital performed RAPN exclusively and the second hospital, OPN exclusively. Cost-effectiveness analysis was conducted from the perspective of the National Health Insurance System (NHIS) by considering the costs of the initial hospital stay and the cost of complications. Clinical outcome was defined by the avoidance of major complications during the 12 months postoperatively. Major complications were absent in 82% of patients in the OPN group and 93% of patients in the RAPN group, with 11% in favor of robotic assistance (p < 0.001). The average cost per patient, including the costs of complications, were, respectively, 9637 € and 8305 € for the OPN and RAPN groups. Robotic assistance was associated with a 1332 € lower cost (p < 0.001). The incremental cost-effectiveness ratio (ICER) is estimated at − 12,039 €. From the perspective of the public payer, robotic assistance was associated with a lower rate of postoperative complications and a lower average cost per patient. Robotic-assisted surgery was an efficient alternative to open surgery in partial nephrectomy. Trial registration number: NCT05089006 (October 22, 2021). [ABSTRACT FROM AUTHOR]

The application and prognostic nature of systemic inflammatory reaction syndrome (SIRS) is still being researched, as using SIRS parameters to predict patient status is cheap, efficient, fast, and easy. The study aimed to determine SIRS markers and postoperative complications occurrence in patients undergoing kidney tumor surgery, and to verify if SIRS occurrence depends on age, sex, BMI (body mass index), comorbidities, patients' general condition before the surgery, type of surgery, intraoperative blood loss, or intraoperative ischemia time. Body temperature, heart rate, respiratory rate, and leukocyte count were measured in patients (n = 285) operated on due to a kidney tumor on the first (T0) and third (T3) postoperative day. Univariable and multivariable logistic regression were used to analyze the factors affecting postoperative SIRS and complications occurrence. T0: SIRS developed in patients with higher BMI, >2 ASA points, and more substantial intraoperative blood loss. T3: SIRS developed in obese or overweight patients, with >2 ASA points, significantly higher relative HR change, lower relative body temperature change, respiratory rate, and leukocyte count. BMI values, preoperative general health status, and the amount of intraoperative blood loss in patients undergoing surgery due to a kidney tumor can contribute to SIRS occurrence. Patient's sex, age, tumor size, type of surgery, operated side, and time of intraoperative ischemia do not affect SIRS occurrence. [ABSTRACT FROM AUTHOR]

Introduction: Multiple studies suggest that cancer leads to activation of clotting and fibrinolysis pathways, elevating the risk of thromboembolic events. Kidney cancer is often complicated by clotting disorders. In this study, we hypothesized that preoperative clotting and fibrinolysis parameters are altered in healthy volunteers and kidney tumor patients. We also hypothesized that these differences may be associated with survival in patients who have undergone operations due to kidney tumors. Material and methods: In this study, 96 patients with kidney tumors and 30 healthy volunteers were recruited at a single university center. All patients were assessed for pre-operative serum concentrations of tissue factor (TF), tissue factor pathway inhibitor (TFPI, total TFPI, full-length TFPI, truncated TFPI), plasmin-antiplasmin complex (PAP), thrombin-antithrombin complex (TAT), von Willebrand factor (vWF), clotting factor XIII A1 (FXIIIA1), D-dimers, and fibrinogen. Additionally, standard peripheral blood morphology was evaluated. Results: Malignant kidney tumors were diagnosed in 85 of 96 tumor patients. In patients with kidney tumors, there were statistically significantly higher concentrations of fibrinogen, D-dimers, TAT, PAF, TF, TFPI, vWF, FXIIIA1, and leukocyte counts compared to the control group. Statistically significant correlations were found between multiple parameters. This points to significant clotting system alterations. Cox stepwise hazard analysis showed that pre-operative fibrinogen and D-Dimer concentrations were significantly associated with survival. Conclusions: In patients with kidney tumors, multiple clotting and fibrinolysis parameters are significantly altered. Routine pre-operative measures should include determination of fibrinogen and D-dimer concentrations as these markers aid in prediction of survival probability. [ABSTRACT FROM AUTHOR]

The primary objective was to evaluate the clinical success rate after endovascular embolization of iatrogenic vascular lesions caused during partial nephrectomy. The secondary objective was to evaluate the technical success and to assess potential effects on renal function. We retrospectively included consecutive patients from our center who underwent selective embolization to treat iatrogenic renal arterial lesions induced during partial nephrectomy between June 2010 and June 2020. The technical and clinical success rates and renal outcomes were collected. We identified 25 patients with 47 pseudoaneurysms and nine arteriovenous fistulas. Among them, eight were treated by coils only, eight by liquid embolization agents only, and nine by both. The technical success rate was 96% after the first attempt and 100% after the second attempt. The median follow-up was 27.1 ± 24.3 months. Clinical success, defined as no need for further hemostatic surgery during follow-up, was also obtained in 96% and 100% of patients with one and two attempts, respectively. Renal function estimated by the modification of diet in renal disease equation did not change significantly despite a mean 13.8% ± 15.1% decrease in kidney functional volume estimated by angiography. No complications were attributable to the endovascular treatment. No significant difference was found across embolization agents; however, the subgroup sizes were small. Endovascular embolization is safe and effective for treating iatrogenic arterial lesions after partial nephrectomy: success rates are high, complications are infrequent, and renal function is maintained. Recommendations by interventional radiology societies are needed to standardize this treatment. [ABSTRACT FROM AUTHOR]

Background: Yolk sac tumor is a germ cell tumor (GCT) that occurs in infants and adolescents and affects various sites. There is a trend to treat pediatric renal tumors before a tissue diagnosis. We report a renal yolk sac tumor clinically misdiagnosed as Wilms tumor, based on ultrasound (US) and MRI. Case Report: This 21-month-old male infant was discovered to have a space occupying lesion in the right kidney. Because the tumor was large, initial radiotherapy preceded surgical resection. Histologically, the tumor was a yolk sac tumor. Conclusion: Imaging examination of renal yolk sac tumor can easily be misdiagnosed as Wilms tumor. SIOP treatment plan for Wilms tumor requires preoperative chemotherapy, which is different from the treatment regimen for yolk sac tumor. Preoperative alpha-fetoprotein could have been helpful in avoiding this clinical misdiagnosis. [ABSTRACT FROM AUTHOR]

Introduction: We aimed to evaluate clinical features, prognostic factors, and treatment preferences in patients with non-clear cell renal cell carcinoma (nccRCC). Methods: Patients with metastatic nccRCC were selected from the Turkish Oncology Group Kidney Cancer Consortium (TKCC) database. Clinical features, prognostic factors, and overall survival (OS) outcomes were investigated. Results: A total of 118 patients diagnosed with nccRCC were included in this study. The median age at diagnosis was 62 years (interquartile range: 56–69). Papillary (57.6%) and chromophobe tumors (12.7%) are common histologic subtypes. Sarcomatoid differentiation was present in 19.5% of all patients. When the patients were categorized according to the International Metastatic RCC Database Consortium (IMDC) risk scores, 66.9% of the patients were found to be in the intermediate or poor risk group. Approximately half of the patients (55.9%) received interferon in the first line. At the median follow-up of 53.2 months (95% confidence interval [CI]: 34.7–71.8), the median OS was 19.3 months (95% CI: 14.1–24.5). In multivariate analysis, lung metastasis (hazard ratio [HR]:2.22, 95% CI: 1.23–3.99) and IMDC risk score (HR: 2.35, 95% CI: 1.01–5.44 for intermediate risk; HR: 8.86, 95% CI: 3.47–22.61 for poor risk) were found to be independent prognostic factors. Conclusion: In this study, survival outcomes are consistent with previous studies. The IMDC risk score and lung metastasis are the independent prognostic factors for OS. This is an area that needs research to better treat this group of patients and create new treatment options. [ABSTRACT FROM AUTHOR]

The accurate classification of kidney tumors necessitates the utilization of various diagnostic techniques. Within the domain of medical imaging tests, the integration of multi-modal medical imaging represents an innovative approach to enhance diagnostic precision. However, the integration of multi-modal medical imaging faces a critical challenge: the insufficiency of correspondingly paired data across modalities, resulting in a paucity of training samples for neural networks. To mitigate this limitation, generative artificial intelligence, specifically generative models capable of generating additional data, thereby addressing the gap in the multi-modal medical imaging record. In our work, our primary objective is to improve the classification results that outperform an existing method of using single-modal medical images. To achieve this, we harness the wealth of information of multi-modal data derived from Contrast-Enhanced Computed Tomography (CECT) and Magnetic Resonance Imaging (MRI), along with their respective subtypes, to determine which specific modality or pair contributes the most effectively to classification. Our work introduces the comprehensive comparison between the different multi-modal fusion techniques, in which the Area Under the Curve (AUC) serves as the benchmark for performance evaluation. Moreover, this work tackles the problem of the unavailability of kidney tumor data by partially recovering from the available data using Conditional CycleGAN, which is part of the image-to-image translation that maps between two different image domains. Through the employment of multi-modal fusion techniques and our proposed recovery of missing data, our research has yielded superior classification results than single-modal classification approaches.

Background: Adherent perinephric fat (APF) is one of the challenging factors of laparoscopic partial nephrectomy (LPN). The aim of this study was to investigate the effect of intraoperative laparoscopic ultrasound (ILUS) on determining renal tumor localization and dissection in patients with APF who underwent LPN. Methods: Prospectively collected data from 517 patients who underwent LPN from October 2010 to September 2020 in tertiary university hospital were evaluated retrospectively. The cohort was divided into two main groups according to the Mayo Adhesive Probability (MAP) score: Group 1 (MAP score ≤3) and Group 2 (MAP score ≥4). After implementing propensity score-matched analysis including the complexity of tumor, age, and body mass index, Group 1 consisted of 202 patients with ≤3 MAP score and Group 2 included 46 patients. Then, both groups were allocated into two subgroups according to whether ILUS was used. Demographics, perioperative features such as perirenal fatty tissue dissection, tumor excision, operation time, and perioperative outcomes accepted as trifecta, considering warm ischemia time, negative surgical margin, and complications were compared. Results: In Group 1, ILUS use did not seem to affect perioperative outcomes in both subgroups. However, ILUS has a positive effect on perirenal fatty tissue dissection (10 versus 19 minutes, P = .011), tumor excision (4 versus 7 minutes, P = .005), and operation time (78 versus 90 minutes, P = .046) in Group 2. Trifecta outcomes were also better in higher MAP scores and ultrasound-used subgroups (P = .019). Conclusions: ILUS should be considered a helpful and effective instrument in overcoming APF in LPN. It might also have a positive effect on trifecta outcomes. [ABSTRACT FROM AUTHOR]

Kidney tumors in childhood and adolescence represent 7% of neoplasias. Its incidence is recorded between two and four years of age, with 80% of cases presenting before five years of age, and it rarely appears after 10 years of age, although cases have even been described in adults. The clinical manifestations presented by children with Wilms tumor are: palpable abdominal mass (75%), abdominal pain (28%), hypertension (26%), gross hematuria (18%), microscopic hematuria (24%), and fever (22%). Below is the case of a 13-year-old female patient with acute abdominal pain, associated with the presence of a palpable mass on the left flank; who presented tumor rupture and was approached as an oncological emergency, the need to consider it as a differential diagnosis in the presence of acute-onset abdominal pain in a pediatric patient stands out. [ABSTRACT FROM AUTHOR]

Partial nephrectomy (PN) is the gold standard surgical treatment for localized kidney cancer. The objective of our study was to compare clinical and perioperative outcomes of open partial nephrectomy (OPN) and robotic-assisted partial nephrectomy (RAPN). We retrospectively collected all patients who underwent PN for kidney cancer between 2007 and 2019 at two French academic urology departments. Clinical and perioperative outcomes and complications were compared between the OPN group and the RAPN group. Recurrence-free survival (RFS) and overall survival (OS) were compared using the log-rank test. We included 405 patients. The maximum follow-up time was 13.6 years in the OPN group and 7.1 years in the RAPN group. The OPN group was associated with more blood loss and longer hospital stay (respectively, 287 ml vs. 62.1 ml; p < 0.001 and 8.54 days vs. 4.96 days; p < 0.001). Ischemia time was shorter in the OPN group (11.4 min vs. 16.9 min; p < 0.001). The rate of complications during hospitalization and after discharge from hospital was higher in the OPN group (respectively, n = 51 vs. 30; p = 0.031 and n = 31 vs. 14; p < 0.001). RFS and OS were similar in both groups. In our study, RAPN has better perioperative outcomes with shorter hospital stay and less blood loss but also fewer early and late complications. However, we did not find any difference in terms of RFS and OS. [ABSTRACT FROM AUTHOR]

Copyright of Hungarian Medical Journal / Orvosi Hetilap is the property of Akademiai Kiado and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

In 2021, approximately 51% of patients diagnosed with kidney tumors underwent surgical resections. One possible way to reduce complications from surgery is to minimise the associated blood loss, which, in the case of partial nephrectomy, is caused by the inadequate repair of branching arteries within the kidney cut during the tumor resection. The kidney vasculature is particularly complicated in nature, consisting of various interconnecting blood vessels and numerous bifurcation, trifurcation, tetrafurcation, and pentafurcation points. In this study, we present a mathematical lumped-parameter model of a whole kidney, assuming a non-Newtonian Carreau fluid, as a first approximation of estimating the blood loss arising from the cutting of single or multiple vessels. It shows that severing one or more blood vessels from the kidney vasculature results in a redistribution of the blood flow rates and pressures to the unaltered section of the kidney. The model can account for the change in the total impedance of the vascular network and considers a variety of multiple cuts. Calculating the blood loss for numerous combinations of arterial cuts allows us to identify the appropriate surgical protocols required to minimise blood loss during partial nephrectomy as well as enhance our understanding of perfusion and account for the possibility of cellular necrosis. This model may help renal surgeons during partial organ resection in assessing whether the remaining vascularisation is sufficient to support organ viability.

(1) Background: Computed tomography (CT) imaging challenges in diagnosing renal cell carcinoma (RCC) include distinguishing malignant from benign tissues and determining the likely subtype. The goal is to show the algorithm’s ability to improve renal cell carcinoma identification and treatment, improving patient outcomes. (2) Methods: This study uses the European Deep-Health toolkit’s Convolutional Neural Network with ECVL, (European Computer Vision Library), and EDDL, (European Distributed Deep Learning Library). Image segmentation utilized U-net architecture and classification with resnet101. The model’s clinical efficiency was assessed utilizing kidney, tumor, Dice score, and renal cell carcinoma categorization quality. (3) Results: The raw dataset contains 457 healthy right kidneys, 456 healthy left kidneys, 76 pathological right kidneys, and 84 pathological left kidneys. Preparing raw data for analysis was crucial to algorithm implementation. Kidney segmentation performance was 0.84, and tumor segmentation mean Dice score was 0.675 for the suggested model. Renal cell carcinoma classification was 0.885 accurate. (4) Conclusion and key findings: The present study focused on analyzing data from both healthy patients and diseased renal patients, with a particular emphasis on data processing. The method achieved a kidney segmentation accuracy of 0.84 and mean Dice scores of 0.675 for tumor segmentation. The system performed well in classifying renal cell carcinoma, achieving an accuracy of 0.885, results which indicates that the technique has the potential to improve the diagnosis of kidney pathology.