Volume 16, Number 2Review ArticlesSolitary Renal Fossa Recurrence of Renal Cell Carcinoma After NephrectomyTreatment ReviewKamran AhmedJi-Jian ChowZahoor FaziliMohammed SheikhMartin SheriffRenal cell carcinoma without metastasis responds well to surgical excision but is known to recur postnephrectomy. In a small but significant number of patients this recurrence is not accompanied by metastasis, which is important as these people benefit from further surgery. We examined 20 articles from the current literature to ascertain how best to treat this condition. Surgical management renders better results than conservative or medical therapies. Readily available investigations such as blood tests and computed tomography can help determine the right patients for surgery in an evidence-based fashion. Current findings have allowed us to suggest a protocol for the treatment of solitary renal fossa recurrence of postnephrectomy renal cell carcinoma. There are further opportunities for study in validating our protocol, and in novel renal cell carcinoma treatment strategies that have not been tested on solitary renal fossa recurrences. [Rev Urol. 2014;16(2):76-82 doi: 10.3909/riu0598] © 2014 MedReviews®, LLCComplicationsManagementRenal cancerRecurrenceNephrectomy
Volume 19, Number 1Review ArticlesSystematic Review of Open Versus Laparoscopic Versus Robot-assisted NephroureterectomySystematic ReviewKamran AhmedEmma MullenBen ChallacombeUpper tract urothelial carcinoma is a relatively uncommon malignancy. The gold standard treatment for this type of neoplasm is an open radical nephroureterectomy with excision of the bladder cuff. This systematic review compares the perioperative and oncologic outcomes for the open surgical method with the alternative surgical management options of laparoscopic nephroureterectomy and robot-assisted nephroureterectomy (RANU). MEDLINE, EMBASE, PubMed, and Cochrane Library databases were searched using a sensitive search strategy. Article inclusion was then assessed by review of abstracts and full papers were read if more detail was required. In all, 50 eligible studies were identified that looked at perioperative and oncologic outcomes. The range for estimated blood loss when examining observational studies was 296 to 696 mL for open nephroureterectomy (ONU), 130 to 479 mL for laparoscopic nephroureterectomy (LNU), and 50 to 248 mL for RANU. The one randomized controlled trial identified reported estimated blood loss and length of stay results in which LNU was shown to be superior to ONU (P < .001). No statistical significance was found, however, following adjustment for confounding variables. Although statistically insignificant results were found when examining outcomes of RANU studies, they were promising and comparable with LNU and ONU with regard to oncologic outcomes. Results show that laparoscopic techniques are superior to ONU in perioperative results, and the longer-term oncologic outcomes look comparable. There is, however, a paucity of quality evidence regarding ONU, LNU, and RANU; data that address RANU outcomes are particularly scarce. As the robotic field within urology advances, it is hoped that this technique will be investigated further using gold standard research methods. [Rev Urol. 2017;19(1):32-43 doi: 10.3909/riu0691] © 2017 MedReviews®, LLCUrothelial carcinomaRobot-assisted nephroureterectomyopen nephroureterectomyLaparoscopic nephroureterectomy