A single-centre experience with tumour tract seeding associated with needle manipulation of renal cell carcinomas E890Cite as: Can Urol Assoc J 2015;9(11-12):E890-93. http://dx.doi.org/10.5489/cuaj.3278 Published online December 14, 2015. AbstractWith the rise in detection of incidental renal masses on imaging, there has been a commensurate rise in the use of percutaneous biopsies for evaluation of these tumours. Tumour tract seeding had previously been one of the most feared complications of percutaneous biopsy of renal cell carcinoma (RCC). Recently, less emphasis has been placed on this complication, with the assertion that it has only been reported eight times in literature, and thus must be exceedingly rare. However, we report two cases of tumour tract seeding associated with percutaneous biopsy and treatment of RCC over a short time period at a single institution. This report challenges the current extremely low estimates of the frequency of this complication and calls for a more realistic assessment. IntroductionWith the advent of cross-sectional imaging, the incidence of renal tumours has been on the rise, as these tumours are increasingly being detected at earlier stages in asymptomatic patients.1-6 One study estimates that up to 66% of RCCs are detected incidentally.7 Importantly, not all incidentally detected renal masses on imaging are RCC or malignant in nature. In a recent large series of laparoscopic partial nephrectomies for renal masses, 28-34% of the tumours were identified to be benign at final histology. The indications for performing percutaneous biopsy of renal tumours were historically limited to diagnosis of lymphoma, metastatic disease, infection, or tumours in patients who have an increased surgical risk. 1,5,7,9 With increasing expertise in biopsy performance and the understanding that not all renal masses are malignant and needing invasive measures (such as ablation or nephrectomy), the role of percutaneous biopsy has been on the rise. [1][2][3]5,6 Moreover, recent assessments of safety of renal mass biopsies state that the overall complication rates range from 1.4-4.7%, with major complications reported only in 0.46% of all patients undergoing renal mass biopsies. In particular, the most feared risk of tumour tract seeding has been estimated to be <0.01% with only eight total reported cases in literature to date. [2][3][4][5][6][7]9,10 We report two recent cases of tumour tract seeding associated with percutaneous biopsy and/or treatment (cryoablation) of renal masses at a single institution, suggesting this complication, although rare, may be underreported in literature. Case reports Patient AA 63-year-old woman initially presented in early 2009, after an incidental finding of a 3 cm enhancing left upper pole renal mass found during computed tomography (CT) scan obtained for evaluation of exacerbation of sarcoidosis. The patient was asymptomatic and underwent CT-guided biopsy of the left renal mass by interventional radiology. The procedure was performed with a 19-gauge coaxial need...

This report provides further support for the use of vesicostomy as an option for surgical management of patients with renal failure with oligohydramnios and severe obstructive lesions identified antenatally. It also indicates the need to update the criteria for antenatal management of oligohydramnios in obstructive and anephric patients.

INTRODUCTION The University of Florida (UF) and the Oak Ridge National Laboratory (ORNL) are evaluating the hygrothermal (heat and moisture flow) performance and durability of sealed attic construction where open cell spray polyurethane foam (ocSPF) insulation is applied directly to the underside of the roof deck. During the 2015–2016 fiscal year and with financial support from the Florida Building Commission (FBC) and the Florida Roofing and Sheet Metal Contractors Association (FRSA), UF and the ORNL Building Technology Research Integration Center (BTRIC) completed Phase I of a study that setup four residential home demonstrations in Florida climate zones CZ-1A and CZ-2A. Field measurements for the homes are listed in Table 1. The four homes are instrumented for measuring temperature and relative humidity of the indoor living space, the outdoor air and the attic air. In addition, the temperature, relative humidity and moisture content of the roof sheathing are being monitored and recorded by remotely-accessible data acquisition equipment. Air leakage tests on the whole house, on the sealed attic and in the HVAC ducts were conducted on all four homes, Table 1. Digital and infrared images were captured to document the thermal performance of the sealed attics. Field tests commenced on June 1, 2016. Data acquisition will continue for one full year to document heat and moisture flows, which, in turn will be used in a second phase of work to benchmark an analytical tool kit for predicting the heat and moisture flows in Florida's hot and humid climate. The second phase of work is pending approval by the FBC.

The presence of metastatic tumor cells in tumor-draining lymph nodes is an important indicator for cancer staging and therapy. Current clinical approaches of assessing lymph node tumor burden require invasive surgery that can be associated with nerve damage and other complications. In this study, a dual-reporter fluorescence molecular imaging approach, previously validated for quantifying targeted reporter binding in various human tumor xenographs, was assessed as a means of quantifying tumor burden in metastatic disease in mice. The utility of the dual-reporter imaging approach to measure tumor burden in sentinel lymph nodes was investigated in a bioluminescent human breast cancer xenograph model in 18 female nude mice. Once the presence of tumor in the lymph node was confirmed by bioluminescent imaging, fluorescently labeled anti-EGFR antibody and an untargeted antibody (labeled with a different fluorophore) were injected intradermally, proximal to the lymph node, and the uptake of the two reporters was imaged simultaneously with a with a flat-panel fluorescent scanner. Preliminary results demonstrated a statistically significant correlation between the dual-reporter measured tumor burden and the bioluminescent measure of tumor burden.

INTRODUCTION AND OBJECTIVE: Urologic surgeries have been previously identified as having high rates of readmission compared to other surgeries. This study aims to identify risk factors leading to presentation to the emergency department (ED) following urologic outpatient surgery.METHODS: We examined all outpatient surgeries performed by urology, general surgery, thoracic surgery, and gynecology occurring at three hospitals within The Ottawa Hospital system between April 1, 2008, and February 28, 2018. We captured all ED visits within 90 days of the outpatient procedure. Surgical characteristics included hospital campus, procedure end time, and day/month/year of procedure. Patient characteristics assessed included age, sex, marital status, presence of primary care provider, socioeconomic status (SES), American Society of Anesthesiologists (ASA) score, and Elixhauser comorbidity index.RESULTS: 38,377 outpatient procedures were performed by the four services assessed over our time period. 5641 ED visits within 90 days were identified. Urological procedures accounted for 47.5% (n [2681) of the patients returning to the ED, representing a 16.2% rate of return to the emergency room following urologic day surgery. Furthermore, urologic patients were more likely to have several visits to the emergency room within 90 days compared to other surgical services (p<0.05). Univariable analyses of individual variables found that increased age, low SES, unmarried status were all associated with higher rates of ED visits (p<0.05). The median ER visit day postprocedure ranged from 5-17 depending on procedure type. Of the noted reasons for emergency presentation, the top 5 causes were directly related to urology with retention (11% of visits), and hematuria (10% of visits) being the most common. Of urological day surgery procedures ureteroscopy (Relative Risk (RR) 3.69, 95% CI 2.17,6.29), Greenlight Laser Photoselective Vaporization of the prostate (RR 3.6, 95% CI 2.05, 6.34), and ureteric stent insertion (RR 3.83, 95% CI 2.17, 6.76) had the highest rates of return to emergency in 90 days on multivariate analysis.CONCLUSIONS: ED visits following urologic outpatient procedures are common. This study identifies risk factors to identify patients that may benefit from additional education or support after outpatient urologic surgery to reduce ED care needs.