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Purpose: To evaluate retrospectively the influence of percutaneous cryoablation for small renal tumors on total and affected kidney function and risk factors associated with worsening function of the affected kidney. Materials and methods: Between April 2016 and March 2022, 27 patients who underwent cryoablation for small renal tumors at our institution participated in this study, which investigated time-dependent changes in postoperative renal function. We evaluated estimated glomerular filtration rates (eGFRs) and split renal function revealed by scintigraphy using 99 m technetium-mercaptoacetyltriglycine (99mTc-MAG3) before cryoablation and at 1 week, 1 month, and 6 months after cryoablation. Numerous variables were analyzed to assess risk factors for worsening renal function. Results: Baseline eGFR (mean ± standard deviation) was 56.5 ± 23.7 mL/min/1.73 m2 (mean ± SD; range, 20.5–112.5). Mean eGFRs at 1 week, 1 month, and 6 months after cryoablation were 57.4 ± 24.5 (19.1–114.9), 57.1 ± 25.1 (21.5–114.9), and 53.8 ± 23.9 mL/min/1.73 m2 (20.0–107.5), respectively. Changes were statistically insignificant (p = 1.0000, = 0.6749, and = 0.0761, respectively). Regarding split renal function, mean baseline contribution of the affected kidney determined by 99mTc-MAG3 was 49.7% ± 6.0% (38.8–63.3%); these rates at 1 week, 1 month, and 6 months after cryoablation were 43.7% ± 8.8 (29.1–70.6%), 46.2% ± 7.7% (32.6–70.3%), and 46.0% ± 8.5% (32.5–67.6%), respectively. Differences from baseline were significant for all periods (p < 0001, < 0001, = 0.0001, respectively). Serum C reactive protein and lactate dehydrogenase at 1 day following cryoablation, tumor's nearness to the collecting system or sinus, and volume of ablated normal renal parenchyma were significantly correlated with decreased contributions of the affected kidney by > 10% after cryoablation. Conclusion: Unlike total renal function, affected kidney function could worsen after cryoablation. [ABSTRACT FROM AUTHOR]

Background: This study aimed to identify disease‐causing variants within a Chinese family affected by Birt–Hogg–Dubé syndrome (BHDS), which arises from an autosomal dominant inheritance pattern attributed to variants in the folliculin (FLCN) gene, recognized as a tumor suppressor gene. Methods: A Chinese proband diagnosed with BHDS due to renal tumors underwent next‐generation sequencing (NGS), revealing a novel variant in the FLCN gene. Sanger sequencing was subsequently performed on blood samples obtained from family members to confirm the presence of this variant. Results: A novel germline frameshift variant (NM_144997.5:c.977dup) was identified in five individuals among the screened family members, marking the first report of this variant. Additionally, a somatic frameshift variant (NM_144997.5:c.1252del) was detected in the renal tumors of the proband. No variant was detected in unaffected family members. Conclusions: A novel heterozygous variant was identified in exon 9 of the FLCN gene, which broadens the spectrum of FLCN variants. We recommend that molecular analysis of the FLCN gene be performed in patients with suspected BHDS and their families. [ABSTRACT FROM AUTHOR]

Wilms tumor (WT) occurring in adults is rare and even much more rarely found to coexist with pregnancy. Clinical outcome in adults is worse overall compared with pediatric patients with WT and is often misdiagnosed with no standardized protocols for care guided by high‐evidence clinical trials. We present a case of a 23‐year‐old woman diagnosed with WT who was found to be pregnant immediately following nephrectomy. Workup findings showed that she had disseminated disease but was successfully managed in a multidisciplinary team setting with modified intrapartum chemotherapy followed by postpartum chemotherapy. In low‐resource settings, management protocols for adult patients with WT can be individualized by multidisciplinary teams to leverage available resources for best outcomes. Synopsis: Disseminated adult Wilms tumor, a rare and challenging condition in pregnancy, can be successfully managed in a low‐resource setting by a multidisciplinary team. [ABSTRACT FROM AUTHOR]

The use of 3D laparoscopic partial nephrectomy has emerged as a cornerstone in the surgical arsenal for addressing renal tumors, particularly in managing challenging cases characterized by deeply seated tumors embedded within the renal parenchyma. In these intricate scenarios, the utilization of intraoperative ultrasound (IOUS) acquires paramount importance, serving as an indispensable tool for guiding and meticulously monitoring the surgical process in real time. To further explore the efficacy of IOUS-guided techniques, we conducted a retrospective study comparing outcomes in patients who underwent partial nephrectomy with IOUS guidance (n = 60) between 2020 and 2022 with a cohort from 2018 to 2019 without IOUS guidance (n = 25). Our comprehensive analysis encompassed various post-operative parameters, including the duration until food resumption, analgesia requirements, and length of the hospital stay. While these parameters exhibited comparable outcomes between the two groups, notable distinctions emerged in the intraoperative metrics. The IOUS-guided cohort demonstrated significantly reduced blood loss, a shorter median operative duration, and diminished ischemia time (p = 0.001). These compelling findings underscore the undeniable benefits of IOUS-guided techniques in not only facilitating the attainment of negative surgical margins but also in enhancing procedural safety and precision, thereby contributing to improved patient outcomes in the management of renal tumors. [ABSTRACT FROM AUTHOR]

Objective. Laparoscopic renal unit-preserving resection is a routine and effective means of treating renal tumors. Image segmentation is an essential part before tumor resection. The current segmentation method mainly relies on doctors manual delineation, which is time-consuming, labor-intensive, and influenced by their personal experience and ability. And the image quality of segmentation is low, with problems such as blurred edges, unclear size and shape, which are not conducive to clinical diagnosis. Approach. To address these problems, we propose an automated segmentation method, i.e. the UNet++ algorithm fusing multiscale residuals and dual attention (MRDA_UNet++). It replaces two consecutive 3 × 3 convolutions in UNet++ with the 'MultiRes block' module, which incorporates coordinate attention to fuse features from different scales and suppress the impact of background noise. Furthermore, an attention gate is also added at the short connections to enhance the ability of the network to extract features from the target area. Main results. The experimental results show that MRDA_UNet++ achieves 93.18%, 92.87%, 93.66%, and 92.09% on the real-world dataset for MIoU, Dice, Precision, and Recall, respectively. Compared to the baseline model UNet++ on three public datasets, the MIoU, Dice, and Recall metrics improved by 6.00%, 7.90% and 18.09% respectively for BUSI, 0.39%, 0.27% and 1.03% for Dataset C, and 1.37%, 1.75% and 1.30% for DDTI. Significance. The proposed MRDA_UNet++ exhibits obvious advantages in feature extraction, which can not only significantly reduce the workload of doctors, but also further decrease the risk of misdiagnosis. It is of great value to assist doctors diagnosis in the clinic. [ABSTRACT FROM AUTHOR]

Objective: Complete endophytic renal tumors (CERTs) are the most challenging for robot-assisted partial nephrectomy (RAPN). This study aimed to determine the impact of CERT on outcomes of RAPN. Methods: All RAPN cases for localized renal tumor undertaken at Yokohama City University Hospital between 2016 and 2023 were enrolled. Tumor characteristics and surgical, functional, and oncologic outcomes of RAPN were compared between CERT and non-CERT groups. Results: Consecutive 666 patients were enrolled, and 76 (11.4%) were identified as CERT (3 points of "E" score). CERT showed smaller tumor diameters (p < 0.001), more predominant hilar tumor (p = 0.029), higher "N" scores (p < 0.001) and "L" scores (p = 0.006) than non-CERT. The CERT group showed longer warm ischemia times (p < 0.001), more frequent positive surgical margins (p = 0.028), and relatively lower trifecta achievement rates (p = 0.101) than the non-CERT group. In multivariable analysis, the CERT was an independent predictor for trifecta achievement but not for pentafecta achievement. Conclusions: CERT was associated with longer warm ischemia time, positive surgical margin, and lower trifecta achievement, but not with surgical complication and pentafecta achievement in RAPN. This study suggested that CERT had limited influence on long-term renal functional preservation; however, it had strong impacts on short-term surgical outcome. [ABSTRACT FROM AUTHOR]

We retrospectively collected baseline, perioperative and follow up data regarding RAPN and MWA from a single academic center. MWA carried a lower burden for the patient in terms of length of stay and medical complications, though it resulted in a higher rate of recurrence. Renal function variation was comparable after the two procedures. Background: Robot assisted partial nephrectomy (RAPN) and microwave ablation (MWA) are 2 of the most advanced techniques for the management of localized small renal masses. Purpose: To compare the perioperative, functional and oncological results of RAPN and MWA. Materials and Methods: Data from 171 consecutive patients undergoing either RAPN or MWA for a localized small renal mass at a single academic center was retrospectively collected. Baseline features included patients' demographics and masses' characteristics. Procedures were compared in terms of perioperative outcomes and renal function variation Progression of a persistent lesion or local recurrence after a complete treatment defined local tumor progression. Descriptive statistics and survival analysis tested the association between predictors and local tumor progression. Results: Of all, 109 and 62 patients underwent RAPN and MWA. Patients in the MWA group were older (P = .002) had higher Charlson Comorbidity Index (CCI) (P < .001) and higher frequency of preoperative chronic kidney disease (P < .001). MWA led to a shorter postoperative hospitalization time (P < .001) and lower incidence of medical complications (6.5% vs. 22.9%, P = .02) than RAPN. GFR decline was similar between groups both at discharge (P = .39) and at the time of last follow up (P = 1.00). A lower rate of secondary interventions (11.7% vs. 2.8%, P = .037) and a better disease-free survival (83.2% vs. 96.5%, P = .027) were reported after RAPN. Conversely, cancer specific and overall survival were comparable (P > .05). At univariate regression analysis, MWA was associated with local tumor progression (HR 3.46, P = .040). Conclusion: MWA displayed a lower perioperative impact, while functional outcomes were similar after each intervention. RAPN resulted superior in terms of tumor eradication, but no difference was noted regarding cancer specific survival. Thus, MWA represents a valid alternative in frail patients, though less radical than RAPN. [ABSTRACT FROM AUTHOR]

Glomus tumors are rare mesenchymal tumors involving cells from the glomus body, smooth muscle, and vasculature, typically found in distal extremities' skin. This case describes a 54-year-old woman with a history of hypothyroidism and hyperlipidemia, incidentally discovered to have a four-centimeter calcified renal tumor. Surgery was performed due to suspected malignancy. Immunohistochemical staining confirmed a renal glomus tumor, positive for muscle actin and smooth muscle actin (SMA). The tumor was benign, and no adjuvant therapy was needed. The patient remained recurrence-free during follow-up. Renal glomus tumors are predominantly benign, with surgical resection as the primary treatment.

Abstract Background This study aimed to identify disease‐causing variants within a Chinese family affected by Birt–Hogg–Dubé syndrome (BHDS), which arises from an autosomal dominant inheritance pattern attributed to variants in the folliculin (FLCN) gene, recognized as a tumor suppressor gene. Methods A Chinese proband diagnosed with BHDS due to renal tumors underwent next‐generation sequencing (NGS), revealing a novel variant in the FLCN gene. Sanger sequencing was subsequently performed on blood samples obtained from family members to confirm the presence of this variant. Results A novel germline frameshift variant (NM_144997.5:c.977dup) was identified in five individuals among the screened family members, marking the first report of this variant. Additionally, a somatic frameshift variant (NM_144997.5:c.1252del) was detected in the renal tumors of the proband. No variant was detected in unaffected family members. Conclusions A novel heterozygous variant was identified in exon 9 of the FLCN gene, which broadens the spectrum of FLCN variants. We recommend that molecular analysis of the FLCN gene be performed in patients with suspected BHDS and their families.

Abstract Kidney diseases result from various causes, which can generally be divided into neoplastic and non-neoplastic diseases. Deep learning based on medical imaging is an established methodology for further data mining and an evolving field of expertise, which provides the possibility for precise management of kidney diseases. Recently, imaging-based deep learning has been widely applied to many clinical scenarios of kidney diseases including organ segmentation, lesion detection, differential diagnosis, surgical planning, and prognosis prediction, which can provide support for disease diagnosis and management. In this review, we will introduce the basic methodology of imaging-based deep learning and its recent clinical applications in neoplastic and non-neoplastic kidney diseases. Additionally, we further discuss its current challenges and future prospects and conclude that achieving data balance, addressing heterogeneity, and managing data size remain challenges for imaging-based deep learning. Meanwhile, the interpretability of algorithms, ethical risks, and barriers of bias assessment are also issues that require consideration in future development. We hope to provide urologists, nephrologists, and radiologists with clear ideas about imaging-based deep learning and reveal its great potential in clinical practice. Critical relevance statement The wide clinical applications of imaging-based deep learning in kidney diseases can help doctors to diagnose, treat, and manage patients with neoplastic or non-neoplastic renal diseases. Key points • Imaging-based deep learning is widely applied to neoplastic and non-neoplastic renal diseases. • Imaging-based deep learning improves the accuracy of the delineation, diagnosis, and evaluation of kidney diseases. • The small dataset, various lesion sizes, and so on are still challenges for deep learning. Graphical Abstract

Synovial sarcomas are a rare and aggressive subtype of soft tissue sarcomas that typically affects young adults and involves the extremities. Synovial sarcoma of the kidney is a rare and aggressive tumor with a poor prognosis, accounting for only 1% of all renal tumors. The imaging features of this tumor often overlap with those of other renal tumors, and a definitive diagnosis can only be made through immunohistochemical analysis. In this case report, we present the case of a 55-year-old female with left flank pain, who was diagnosed with primary renal synovial sarcoma following a left-sided radical nephrectomy. Despite initial successful surgical intervention, restaging scans showed local recurrence and metastatic disease, which was subsequently managed with 6 cycles of chemotherapy followed by radiation therapy with palliative intent. This case underscores the importance of early detection and aggressive management of rare renal tumors to improve patient outcomes.

Background: Surgical removal of huge renal and retroperitoneal tumors, such as adrenal cortical carcinoma or renal cell carcinoma with inferior vena cava (IVC) invasion, remains a challenge for urologists. Aim: Herein, we describe our experience with the modified Makuuchi incision for huge renal and retroperitoneal tumors. Methods: We applied the modified Makuuchi incision in 10 patients with a huge renal or retroperitoneal tumor. Another 11 patients with a huge renal or retroperitoneal tumor using different surgical incisions other than modified Makuuchi incision were collected for comparison. The modified Makuuchi incision of the abdomen is initiated in the cephalad to the xiphoid, extended 1 cm above the umbilicus, and then extended laterally to the lateral flank. Through the incision, we mobilized the colon, and when the renal space was seen, the tumor was removed. If an invasion of a nearby organ occurred, a general or cardiovascular surgery specialist was consulted for combined surgery. The patients' age ranged from 43 to 82 years (three men and seven women). Results: The modified Makuuchi incision provided good and rapid exposure. No unexpected organ injuries occurred during surgery. There were no wound-related complications, such as dehiscence or incisional hernia, after 3 months of follow-up. Partial hepatectomy, splenectomy, distal pancreatectomy, and thrombectomy of the IVC thrombus were performed through the same incision. Conclusion: Our experience demonstrated that the modified Makuuchi incision is a good choice for patients with huge renal and retroperitoneal tumors, even those with nearby organ invasion.

Abstract Background Follicular dendritic cell sarcoma (FDCS) is a rare low-grade tumor of the lymph nodes, but roughly one-third of the cases emerge from extranodal sites, posing diagnostic challenges. Case presentation In this report, we present the case of a 59-year-old lady who complained of renal colic. During investigation, a kidney tumor was discovered. A radical nephrectomy was performed, and histological examination identified the tumor as a sarcomatoid renal cell carcinoma. The case was then referred to a genitourinary pathologist for further evaluation. The tumor cells exhibited positive staining for CD21, CD23, somatostatin receptor 2 A, and MDM2 expression. Additionally, MDM2 gene amplification was confirmed by the FISH study. Ultimately, the tumor was diagnosed as a primary renal FDCS. The patient was placed under active oncological surveillance and did not receive any further therapy. Remarkably, after 91 months of follow-up, she remains tumor-free. Conclusion This case represents a well-documented primary renal FDCS. Our aim in presenting this extremely rare tumor is to enhance awareness and highlight the importance of considering FDCS in the differential diagnosis.

Introduction: The most common sites of clear cell renal cell carcinoma(ccRCC) metastasis are the lung, bones, liver and brain; eyelid metastasis is a rare occurrence. Case presentation: We report a case of ccRCC metastasis to the left eyelid after radical nephrectomy, and remission after sunitinib treatment. Conclusions: Although the probability of eyelid metastasis rate is very low, tumor metastasis to the eyelid skin is possible after radical nephrectomy. Therefore, any rash like changes on the skin during the review procedure cannot be ignored by the physician. [ABSTRACT FROM AUTHOR]

Thauvin‐Robinet‐Faivre syndrome (#617107) is a rare autosomal recessive overgrowth syndrome characterized by intellectual disability, facial dysmorphism, macrocephaly, and variable congenital malformations. It is caused by homozygous or compound heterozygous FIBP gene mutations. The FIBP gene is located on the 11q13.1 region and codes the acidic fibroblast growth factor intracellular binding protein, which is involved in the fibroblast growth factor (FGF) signaling pathway. FGF signaling is required for neurogenesis and neuronal precursor proliferation. The FGF controls cell proliferation, differentiation, and migration in embryonic development and in adult life. Overgrowth syndromes consist of a wide spectrum disorders characterized by prenatal and postnatal excess growth in weight and length, often associated malformations, intellectual disability, and neoplastic predisposition. Embryonic tumors are especially common in these syndromes. Thauvin‐Robinet‐Faivre syndrome is a recently described overgrowth syndrome with typical facial dysmorphic and clinical features. To date, only four patients have been reported with this disorder. Herein, two new cases of Thauvin‐Robinet‐Faivre syndrome are reported with overgrowth, intellectual disability, typical dysmorphic signs in one dysplastic kidney, and a novel homozygous FIBP gene variant. Exome sequencing analysis showed that both affected siblings share the same homozygous c. 412‐3_415dupCAGTTTG FIBP gene variant. Reporting two new cases with this rare autosomal recessive overgrowth syndrome with a novel FIBP gene variant will support and expand the clinical spectrum of Thauvin‐Robinet‐Faivre syndrome. Also discussed will be the function of FIBP in tumorigenesis and the possible renal tumor susceptibility in heterozygous carriers will be emphasized. [ABSTRACT FROM AUTHOR]

To investigate the potential of amide proton transfer-weighted (APTw) MRI in identifying benign and malignant renal tumors and to evaluate whether APTw MRI can add diagnostic value to diffusion-weighted imaging (DWI). Participants with renal tumor underwent preoperative multiparametric MRI, including APTw MRI and DWI. The APTw and apparent diffusion coefficient (ADC) of malignant tumors and benign tumors were calculated independently by two radiologists and compared. The value of the mean APTw and the mean ADC for differentiating malignant and benign tumors was evaluated by receiver operating characteristic analysis. In total, 65 participants (mean age, 59 years ±14; 41 men) were evaluated: 54 with malignant and 11 with benign renal tumors. Malignant renal tumors showed higher mean APTw values [2.03% (1.63) vs 1.00% (1.60); P < 0.01] and lower mean ADC values (1.22 × 10-3 mm2/s ± 0.37 vs 1.51 × 10-3 mm2/s ± 0.37; P < 0.05) than benign renal tumors. The area under the receiver operating characteristic curve (AUC) of APTw, ADC and the combination of them for the identification of benign and malignant renal tumors was 0.78(95% CI: 0.66, 0.87; P < 0.001),0.70(95% CI: 0.54, 0.86; P < 0.05) and 0.79 (95% CI: 0.67, 0.88; P < 0.001). The optimal cutoff value for mean APTw was 2.14% (sensitivity, 74%; specificity, 73%). There was no difference between these three parameters for differentiating malignant from benign renal tumors (P > 0.05). The APTw MRI has the potential use as an imaging biomarker for renal malignant and benign tumors. [ABSTRACT FROM AUTHOR]

Clear cell sarcoma of the kidney (CCSK) is a rare primary renal tumor in children. It is known for its propensity to metastasize to bones and lungs at initial diagnosis. Distant metastatic relapses occur in about 15–16% of the patients, with the brain being the most frequent site of relapse. Imaging features of brain metastases from CCSK have only been reported in a few cases and most reports lack a detailed description of the imaging findings. We present brain magnetic resonance imaging (MRI) findings in an infant with relapsed CCSK who developed multiple parenchymal metastases with concentric signal alterations and no tumor-associated edema. [ABSTRACT FROM AUTHOR]

Background: Follicular dendritic cell sarcoma (FDCS) is a rare low-grade tumor of the lymph nodes, but roughly one-third of the cases emerge from extranodal sites, posing diagnostic challenges. Case presentation: In this report, we present the case of a 59-year-old lady who complained of renal colic. During investigation, a kidney tumor was discovered. A radical nephrectomy was performed, and histological examination identified the tumor as a sarcomatoid renal cell carcinoma. The case was then referred to a genitourinary pathologist for further evaluation. The tumor cells exhibited positive staining for CD21, CD23, somatostatin receptor 2 A, and MDM2 expression. Additionally, MDM2 gene amplification was confirmed by the FISH study. Ultimately, the tumor was diagnosed as a primary renal FDCS. The patient was placed under active oncological surveillance and did not receive any further therapy. Remarkably, after 91 months of follow-up, she remains tumor-free. Conclusion: This case represents a well-documented primary renal FDCS. Our aim in presenting this extremely rare tumor is to enhance awareness and highlight the importance of considering FDCS in the differential diagnosis. [ABSTRACT FROM AUTHOR]

This study aims to evaluate the clinical diagnostic value of contrast-enhanced ultrasound combined with microflow imaging (CEUS-MFI) in the differential diagnosis of benign and malignant renal tumors. All patients underwent CEUS, MFI, color doppler flow imaging (CDFI), and CEUS-MFI. The efficacies of these different diagnostic modalities in diagnosing benign and malignant renal tumors were evaluated by Kappa consistency test and the receiver operating characteristic (ROC) curve, with pathological findings serving as the gold standard. CDFI, MFI and CEUS-MFI all demonstrated higher blood flow in malignant tumors compared with benign tumors. Compared with benign tumors, CDFI detected a higher rate of punctate and linear Adler grade 2 and 3 blood flows in malignant tumors, as well as peripheral semicircular or annular blood flow. MFI identified a high rate of peripheral circumferential blood flow and irregular vascular morphology in malignant tumors, with most exhibiting Adler grade 3 blood flow. In addition, CEUS-MFI showed more dendritic or irregular Adler grade 2 or 3 blood flows in malignant renal tumors than MFI alone. Further analysis showed that CEUS-MFI had the highest consistency with pathological diagnosis (Kappa = 0.808). The ROC curve showed that the area under the curve (AUC) for CEUS-MFI in differentiating between benign and malignant lesions was 0.898, significantly outperforming other single diagnostic methods. With its capability to display microvascular information and assess overall pathological characteristics, MFI can accurately predict the nature of renal tumors and assist in surgical planning.

The aim of this study is to compare perioperative parameters of laparoscopic partial nephrectomy and open partial nephrectomy in renal tumor management, and to evaluate the effect of using novel method of indocyanine green navigation in segmental ischemia on these parameters. The prospective study included 455 patients (89 laparoscopic partial nephrectomies, 366 open partial nephrectomies). Sub-groups (n=39, 32, 18) in Laparoscopic partial nephrectomy employed diverse ischemia techniques, including full warm ischemia, segmental ischemia with indocyanine green navigation and segmental ischemia without navigation. Parameters assessed encompassed estimated blood loss, ope­rative time, warm ischemia time, and changes in estimated glomerular filtration rate. Covariate-balancing propensity scores ensured homogeneity. Statistical analysis included the Wilcoxon signed-rank test, for two matched groups. Two-sided p-values were reported for all statistical tests, a p-value

Renomedullary interstitial cell tumor (RMICT), referred to as a medullary fibroma, is almost always asymptomatic and incidentally identified either at autopsy or upon resection of the kidney for other reasons. Although a few cases of RMICTs that are large in size and clinically symptomatic have been reported, there are few reports of RMICTs contrasting imaging findings with pathological findings. In this report, we describe a relatively large RMICT case of 3 cm in size, focusing on the radiologic-pathologic correlation.

Objective To investigate the feasibility and safety of modified enhanced recovery after surgery (ERAS) in laparoscopic partial nephrectomy. Methods A retrospective analysis was conducted with the clinical data of renal tumor patients treated with laparoscopic partial nephrectomy in the Urology Department of Peking Union Medical College Hospital from May 2019 to June 2021. According to the peri-operative ERAS strategy, they were divided into modified ERAS group and conventional group. The postoperative recovery and complications of the two groups were compared. Results A total of 243 patients were enrolled, including 142 in the modified ERAS group and 101 in the conventional group. There was no significant difference between the two groups in baseline of indicators such as region, age, gender and tumor stage. The time records of first drinking water, the time of first exhaust, the first off-bed movement, catheter removal and drainage tube removal, the post-operative hospital stay and the total expense of hospitalization in the improved ERAS group were significantly superior to those in the conventional group (all P＜0.05). Conclusions The application of improved ERAS during the peri-operative period of laparoscopic partial nephrectomy may accelerate post-operative recovery.

Objective To study the expression of long-chain non-coding RNA (lncRNA) RP11-626G11.3 in renal cancer tissues and cell lines, and to explore the effect of knockdown of RP11-626G11.3 on the biological behavior of renal cancer cells. Methods The GEPIA database was used to analyze the expression of RP11-626G11.3 in renal cancer tissues and adjacent tissues, and the TCGA database was used to analyze the relationship between the expression of RP11-626G11.3 and the survival time of renal cancer patients. The expression of RP11-626G11.3 in various renal cancer cell lines was detected by qPCR. The renal cancer cells with the highest expression of RP11-626G11.3 were selected and transfected with control plasmid (si-NC group) and RP11-626G11.3 silencing plasmid (si-RP11-626G11.3 group). Cell proliferation and migration were examined by MTT assay and cell scratch assay. The microRNA (miRNA) binding to RP11-626G11.3 was found by bioinformatics method, and verified by dual-luciferase reporter gene experiment. The expression of miR-532-3p in the two groups of cells was detected by qPCR. Western blot was used to detect the expression levels of Wnt/β-catenin signaling pathway in the two groups of cells. Results Compared with adjacent tissues, the expression of RP11-626G11.3 was up-regulated in renal cancer tissues (P＜0.01). Compared with patients with high expression of RP11-626G11.3, patients with low expression of RP11-626G11.3 had a longer survival time (P＜0.01). Compared with immortalized renal tubular epithelial cells, the expression of RP11-626G11.3 was up-regulated in renal cancer cell lines (P＜0.01), and the expression of RP11-626G11.3 was the highest in OS-RC-2 cells (P＜0.01). Compared with si-NC group, the viability of OS-RC-2 cells in si-RP11-626G11.3 group was significantly decreased (P＜0.05) with decreased cell migration rate(P＜0.01). RP11-626G11.3 was found to target at miR-532-3p (P＜0.01). Compared with the si-NC group, the expression of miR-532-3p in OS-RC-2 cells in the si-RP11-626G11.3 group was significantly up-regulated (P＜0.01), and the Wnt/β-catenin signaling pathway proteins β-catenin, Axin2, C-myc, cyclin D1 and MMP7 decreased. Conclusions The expression of RP11-626G11.3 is increased in renal cancer tissues and cell lines. Knockdown of RP11-626G11.3 inhibits the proliferation and migration of renal cancer cells by regulating the expression of miR-532-3p.

Objective To investigate the feasibility and safety of modified enhanced recovery after surgery (ERAS) in laparoscopic partial nephrectomy. Methods A retrospective analysis was conducted with the clinical data of renal tumor patients treated with laparoscopic partial nephrectomy in the Urology Department of Peking Union Medical College Hospital from May 2019 to June 2021. According to the peri-operative ERAS strategy, they were divided into modified ERAS group and conventional group. The postoperative recovery and complications of the two groups were compared. Results A total of 243 patients were enrolled, including 142 in the modified ERAS group and 101 in the conventional group. There was no significant difference between the two groups in baseline of indicators such as region, age, gender and tumor stage. The time records of first drinking water, the time of first exhaust, the first off-bed movement, catheter removal and drainage tube removal, the post-operative hospital stay and the total expense of hospitalization in the improved ERAS group were significantly superior to those in the conventional group (all P＜0.05). Conclusions The application of improved ERAS during the peri-operative period of laparoscopic partial nephrectomy may accelerate post-operative recovery. [ABSTRACT FROM AUTHOR]

The treatment of bilateral Wilms tumors (BWT) involves curing the cancer, preserving long-term renal function, and maintaining a good quality of life. Established methods for achieving these goals include preoperative chemotherapy and nephron-sparing surgery (NSS). This study aimed to evaluate the experience of a single institution in treating patients with BWT. We analyzed cases of BWT treated at the Pediatric Oncology Institute—GRAACC—Federal University of São Paulo over a period of 35 years. Bleeding control was performed with manual compression of the renal parenchyma. Thirty-three patients were included in the study. Thirty cases were synchronous tumors. The mean age at diagnosis was 30.4 months (±22 m) and 66.7% were girls. The median follow-up period was 83 months. Neoadjuvant chemotherapy was the primary approach in most patients (87.9%), with a simultaneous upfront surgical approach performed in 84.8%. Most patients underwent bilateral NSS (70.4%). There were no early complications in this series, but 39.4% had clinical complications. The five-year survival rate was 76%. Therefore, it is clear that the surgical approach to BWT plays a crucial role in achieving good outcomes. However, it is difficult to standardize surgical techniques and technology may have the potential to enhance safety. [ABSTRACT FROM AUTHOR]

Introduction: Renal cryoablation displays a profile of high tolerance, including in a frail population. Cryoablation appears as a validated alternative treatment to surgery for renal tumors smaller than 4 cm. However, evidence is lacking for larger tumors, despite encouraging data for tumors up to 7 cm. Material and methods: This retrospective descriptive study of a population with a stage T1b renal tumor treated by cryoablation was conducted at the Nantes University Hospital between January 2009 and July 2021. Primary endpoint was 3-year rate of local recurrence. Secondary endpoints included technical efficacy, overall and cancer-specific survivals, and safety assessment. Results: A total of 63 patients were analyzed. Three-year rate of local recurrence was 11.1%. Primary and secondary technical efficacies were achieved in 88.9% and 96.8% of patients, respectively, and 3-year overall and cancer-specific survival were 87.3% and 95.2%, respectively. Most patients (73%) experienced no complications, 13% of patients had minor (CIRSE grades 1 or 2) adverse effects, and 13% had severe but non-lethal (CIRSE grade 3) adverse effects. One patient died following cryoablation due to colic perforation. The most common AE (all grades) was hemorrhage (9.5%). Discussion: This study showed a good efficacy and safety of cryoablation for renal tumors up to 7 cm (T1b). Our results were consistent with a rather sparse literature and contributed to guide future recommendations about cryoablation as an alternative to surgery for T1b renal tumors. [ABSTRACT FROM AUTHOR]

Objectives: To develop and validate a machine learning-based CT radiomics classification model for distinguishing benign renal tumors from malignant renal tumors. Methods: We reviewed 499 patients who underwent nephrectomy for solid renal tumors at our institution between 2003 and 2021. In this retrospective study, patients who had undergone a computed tomography (CT) scan within 3 months before surgery were included. We randomly divided the dataset in a stratified manner as follows: 75% as the training set and 25% as the test set. By using various feature selection methods and a dimensionality reduction method exclusively for the training set, we selected 160 radiomic features out of 1,288 radiomic features to classify malignant renal tumors. Results: The training set included 396 patients, and the test set included 103 patients. The percentage of extracted radiomic features from patients was 32% (385/1218) after the reproducibility test. In terms of the average Area Under the Receiver Operating Characteristic Curve (AU-ROC) and the average Area Under the Precision-Recall Curve (AU-PRC), the Random Forest model achieved better performance (AU-ROC = 0.725; AU-PRC = 0.899). An average accuracy of 0.778 was obtained on evaluation with the hold-out test set. At the optimal threshold, the Random Forest model showed an F1 score of 0.746, precision of 0.862, sensitivity of 0.657, specificity of 0.651, and Negative Predictive Value (NPV) of 0.364. Conclusions: Our machine learning-based CT radiomics classification model performed well for the independent test set, indicating that it could be a useful tool for discriminating between malignant and benign solid renal tumors. [ABSTRACT FROM AUTHOR]

In October X, a 55-year-old woman visited her previous doctor due to abdominal pain. A simple CT scan of the abdomen was performed, and findings of an 8-mm-sized angiomyolipoma (AML) or fatty tumor in the right renal pole and right renal sinus were noted. The lesion in the right renal pole extended from the right renal vein (RV) into the inferior vena cava (IVC), forming an embolus-like structure. The patient was referred to our department in November of the same year for close examination and treatment. At the initial visit, a contrast-enhanced MRI scan of the abdomen showed a nodule on the dorsal surface of the upper pole of the right kidney and a structure with a continuous fatty signal in the lumen of the right RV and the IVC. A preoperative diagnosis of multiple AML extensions within the right RV and IVC or intravascular lipoma was made, and open right nephrectomy and tumor embolization were performed in February X+1. After blocking the IVC and the left RV, the right RV was cut off near the IVC bifurcation, and the right kidney and tumor embolus were removed en bloc. The pathological diagnosis was AML. AML is a benign mesenchymal tumor. Although rare, an extrarenal extension may occur, as seen in the present case. Nephrectomy is often the treatment of choice, as in the case of tumor embolization of renal cell carcinoma, but it is essential to fully understand the status of the intravascular tumor extension by preoperative imaging and to carefully plan the surgery. [ABSTRACT FROM AUTHOR]

To study the expression of long-chain non-coding RNA (lncRNA) RP11-626G11.3 in renal cancer tissues and cell lines, and to explore the effect of knockdown of RP11-626G11.3 on the biological behavior of renal cancer cells. Methods The GEPIA database was used to analyze the expression of RP11-626G11.3 in renal cancer tissues and adjacent tissues, and the TCGA database was used to analyze the relationship between the expression of RP11-626G11.3 and the survival time of renal cancer patients. The expression of RP11-626G11.3 in various renal cancer cell lines was detected by qPCR. The renal cancer cells with the highest expression of RP11-626G11.3 were selected and transfected with control plasmid (si-NC group) and RP11-626G11.3 silencing plasmid (si-RP11-626G11.3 group). Cell proliferation and migration were examined by MTT assay and cell scratch assay. The microRNA (miRNA) binding to RP11-626G11.3 was found by bioinformatics method, and verified by dual-luciferase reporter gene experiment. The expression of miR-532-3p in the two groups of cells was detected by qPCR. Western blot was used to detect the expression levels of Wnt/β-catenin signaling pathway in the two groups of cells. Results Compared with adjacent tissues, the expression of RP11-626G11.3 was up-regulated in renal cancer tissues (P＜0.01). Compared with patients with high expression of RP11-626G11.3, patients with low expression of RP11-626G11.3 had a longer survival time (P＜0.01). Compared with immortalized renal tubular epithelial cells, the expression of RP11-626G11.3 was up-regulated in renal cancer cell lines (P＜0.01), and the expression of RP11-626G11.3 was the highest in OS-RC-2 cells (P＜0.01). Compared with si-NC group, the viability of OS-RC-2 cells in si-RP11-626G11.3 group was significantly decreased (P＜0.05) with decreased cell migration rate(P＜0.01). RP11-626G11.3 was found to target at miR-532-3p (P＜0.01). Compared with the si-NC group, the expression of miR-532-3p in OS-RC-2 cells in the si-RP11-626G11.3 group was significantly up-regulated (P＜0.01), and the Wnt/β-catenin signaling pathway proteins β-catenin, Axin2, C-myc, cyclin D1 and MMP7 decreased. Conclusions The expression of RP11-626G11.3 is increased in renal cancer tissues and cell lines. Knockdown of RP11-626G11.3 inhibits the proliferation and migration of renal cancer cells by regulating the expression of miR-532-3p. [ABSTRACT FROM AUTHOR]

The aim of this study is to compare perioperative parameters of laparoscopic partial nephrectomy and open partial nephrectomy in renal tumor management, and to evaluate the effect of using novel method of indocyanine green navigation in segmental ischemia on these parameters. The prospective study included 455 patients (89 laparoscopic partial nephrectomies, 366 open partial nephrectomies). Sub-groups (n=39, 32, 18) in Laparoscopic partial nephrectomy employed diverse ischemia techniques, including full warm ischemia, segmental ischemia with indocyanine green navigation and segmental ischemia without navigation. Parameters assessed encompassed estimated blood loss, operative time, warm ischemia time, and changes in estimated glomerular filtration rate. Covariate-balancing propensity scores ensured homogeneity. Statistical analysis included the Wilcoxon signed-rank test, for two matched groups. Twosided p-values were reported for all statistical tests, a p-value <0.05 was considered to be statistically significant. The findings of the conducted research indicate that open partial nephrectomy has revealed significant differences in estimated blood loss, operative time, and warm ischemia time, in favor of open partial nephrectomy. Laparoscopic partial nephrectomy offers advantages in preserving renal function and minimizing estimated Glomerular Filtration Rate decline compared to open partial nephrectomy. The utilization indocyanine green navigation, facilitates precise and limited ischemia, contributing to enhanced preservation of renal function. Surgeons must weigh these considerations for optimal renal tumor management. [ABSTRACT FROM AUTHOR]

Ossifying Renal Tumor of Infancy (ORTI) represents an extremely rare and benign renal neoplasm, with limited cases published in the literature. Predominantly characterized by painless and intermittent gross hematuria, the diagnostic evaluation is effectively facilitated through ultrasound, computed tomography, and magnetic resonance imaging. Despite progress, its etiology has not yet been elucidated. We report an additional case with an unusual clinical presentation.

Mixed epithelial and stromal tumor (MEST) of the kidney is a rare benign tumor with malignant potential, and is characterized by epithelial and stromal proliferation with a variety of cellularity and growth pattern. MEST of the kidney is often depicted as a well-defined, solid mass with a cystic component. However, due to the rarity of the disease, there are no reports of its progression in serial imaging examinations. This report presents the case of a 68-year-old woman with MEST who was followed for 13 years by computed tomography (CT). To the best of our knowledge, this is the first report of image findings of MEST of the kidney over a follow-up period longer than 10 years.

The use of 3D laparoscopic partial nephrectomy has emerged as a cornerstone in the surgical arsenal for addressing renal tumors, particularly in managing challenging cases characterized by deeply seated tumors embedded within the renal parenchyma. In these intricate scenarios, the utilization of intraoperative ultrasound (IOUS) acquires paramount importance, serving as an indispensable tool for guiding and meticulously monitoring the surgical process in real time. To further explore the efficacy of IOUS-guided techniques, we conducted a retrospective study comparing outcomes in patients who underwent partial nephrectomy with IOUS guidance (n = 60) between 2020 and 2022 with a cohort from 2018 to 2019 without IOUS guidance (n = 25). Our comprehensive analysis encompassed various post-operative parameters, including the duration until food resumption, analgesia requirements, and length of the hospital stay. While these parameters exhibited comparable outcomes between the two groups, notable distinctions emerged in the intraoperative metrics. The IOUS-guided cohort demonstrated significantly reduced blood loss, a shorter median operative duration, and diminished ischemia time (p = 0.001). These compelling findings underscore the undeniable benefits of IOUS-guided techniques in not only facilitating the attainment of negative surgical margins but also in enhancing procedural safety and precision, thereby contributing to improved patient outcomes in the management of renal tumors.