Objective To evaluate prospectively the accuracy of computer-aided three-dimensional (3D) volumerendered computed tomography (CT) in determining the appropriate anatomical limits (tumour size, tumour location, multifocality and vascular supply) and as a potential tool in the preoperative simulation of nephron-sparing surgery (NSS) in patients with small-volume renal cell carcinoma (RCC). Patients and methods The study included 36 patients who underwent transperitoneal radical nephrectomy for RCC of <4 cm diameter. Helical CT was undertaken before surgery and the extent of the tumour, the course of major renal arteries and veins, and the relationship of the tumour to the collecting system were shown by 3D volume-rendered CT. The CT ®ndings were compared with the pathological results of all kidney specimens, obtained using 3-mm stepsections. Results Before nephrectomy, 39 renal tumours were identi®ed in the 36 patients; three renal lesions of <4 mm were not detected. All main venous branches and 42 of 43 arteries were identi®ed by 3D volumerendered CT. Knowing these features, a partial nephrectomy was simulated; a surgical lesion to the pelvicalyceal or vascular system which would have been produced by the simulated surgery was displayed in colour on the simulated surface of the section. Conclusion Computer simulation provided an excellent 3D reconstruction of all kidneys, including the tumour, vasculature and renal hilum, allowing a signi®cantly better preoperative evaluation of the renal mass. Visualizing possible resection margins and predicting the operative risks seem to be major advantages of this new method, especially when preparing for complex surgery. Reconstructed 3D CT appears to be a useful tool for de®ning the indications for and limitations of NSS.

Purpose: The most worrying problem with renal cell carcinoma (RCC) seems to be the prediction of metastases by means of tumor-specific markers. Therefore, much effort is committed to the development of new markers. Materials and Methods: The level of latent transforming growth factor β1 (TGF-β1) was measured in plasma samples by ELISA. These samples were collected from patients with RCC before they underwent radical nephrectomy, from patients 1 h after extracorporeal lithotripsy, from patients with pyelonephritis, and from healthy controls. Results: In all cases of RCC the levels of latent TGF-β1 in plasma were much higher (n = 20, 41.0 ± 13.9 ng/ml, range 19.3–78.1 ng/ml) than in healthy controls (n = 20, 3.8 ± 2.9 ng/ml, range 0.6–9.9 ng/ml, p < 0.0001). The TGF-β1 levels in plasma after extracorporeal lithotripsy (n = 20, 7.4 ± 4.64 ng/ml, range 2.9–21.7 ng/ml, p < 0.01) and in patients suffering from pyelonephritis (n = 20, 18.93 ± 14.2 ng/ml, range 4.2–46.7 ng/ml, p < 0.001) were also higher than in healthy controls. Conclusion: We conclude that increased levels of latent TGF-β1 are common in the plasma of RCC patients. The TGF-β1 plasma level in RCC was found to be significantly higher than in cases of inflammation. Thus, TGF-β1 is a possible tumor-prognostic marker in RCC.

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Background: The indication for elective nephron-sparing surgery (NSS) in renal cell carcinoma (RCC) is under discussion in the urological literature. The main problem of NSS is the multifocality of RCC. The presented study was performed to asses the accuracy of pre- and intraoperative ultrasound (US), and computerized tomography (CT) in determination of tumor size and detection of multifocal lesions. Materials and Methods: Tumor size was measured by preoperative US and CT and compared with the tumor diameters in gross sections of the neoplastic kidneys. Multifocality was determined by 3-mm step sectioning of the nephrectomy specimen, and the results were correlated with preoperative US and CT on the one hand, and the ex situ sonography of the nephrectomized kidney on the other hand. Results: US and CT show similar results in the determination of the tumor size. In only 22.9%, preoperative US and CT were able to detect multifocal tumors. Ex situ sonography had a sensitivity of 40.0% and a specificity of 87.2% in this regard. Conclusions: In preparation for nephron-sparing surgery of renal cell carcinoma, neither preoperative routine imaging, nor intraoperative ultrasound can safely predict multifocal lesions of renal cell carcinoma.

Introduction and Objectives: Numerous studies have reported an increasing incidence of small renal cell carcinoma (RCC). De novo RCC in a renal allograft is a rare event and has special implications in renal transplant recipients. The objective of this study was to retrospectively evaluate the incidence of RCC in renal graft recipients and donors and to determine a procedure in cases with newly detected small renal tumors at the time of kidney preparation before transplantation. Material andMethods: We mailed a questionnaire to 38 German transplant clinics and received answers from 27 centers. A total of 10,997 renal graft recipients were included in the period of 1990–1998. Results: In 30 kidneys (0.273%) RCC was detected at the time of preparation before transplantation. There were 23 male and 3 female donors. No bilateral RCC was described. The mean age of the donors with RCC was 50.9 years (range 37–72 years). The tumors had a mean size of 2.2 cm (range 0.4–6 cm). 67% of the patients had a renal tumor smaller than 20 mm. In 26/27 centers the decision to transplant relies on the result of the immediate section for microscopic examination. 16 patients (0.145%) developed RCC 3–12 years after renal transplantation (mean 7.4 years). The mean tumor size was 2.5 cm (range 2–2.8 cm). In 50% a grade 1 and in the other 50% a grade 2 carcinoma was found. Conclusions: Because of the RCC incidence in donor candidates we recommend an ultrasound screening of the native kidneys before renal explantation and an immediate preparation of the kidney surface especially in donors older than 45 years. In cases with small renal lesions we recommend an immediate section for microscopic examination before transplantation to prevent tumor implantation into an otherwise healthy patient. The frequency of RCCs after renal transplantation necessitates careful clinical and instrumental examinations in organ-transplanted recipients both before and at regular intervals after transplantation, including the patient’s kidneys.