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the presence of diabetes mellitus or other comorbid emphysematous infections of the urinary tract. RESULTSIn all, 102 published papers, including 135 cases of EC, were reviewed; the median patient age was 66 years, 64% were women and 67% had diabetes mellitus. Most cases were diagnosed using plain films of the abdomen (84%), although more recently, computed tomography was the primary imaging method. Escherichia coli was the most commonly isolated organism. Most patients were treated with medical management alone (90%), while 10% of infections were treated with a combination of medicine and surgery. The overall death rate was 7%. CONCLUSIONSEC is the most common and typically the least severe gas-forming infection of the urinary tract. Prompt diagnosis and treatment is warranted to prevent the potential morbidity and mortality of this infectious condition.

It has been more than 30 years since the Bosniak classification of cystic renal masses was first proposed (1). This CT-based classification was introduced in 1986 and originally divided cystic renal masses into one of four classes after exclusion of infectious, inflammatory, and vascular etiologies (Table 1) (1). Since then, refinements have reduced the number of benign masses in Bosniak class III (2-9). For example, Bosniak IIF (where the F is for follow-up) was added for cystic masses with many thin (or minimally thickened) septa with "perceived" enhancement, large (.3 cm) homogeneous nonenhancing hyperattenuating masses, and masses with thick or non-border-forming calcification.Bosniak summarized these changes in 2012 and contended that Bosniak I and II masses were "clearly benign," Bosniak IV masses were "clearly malignant," Bosniak IIF masses were "probably benign," and Bosniak III masses were "indeterminate" (approximately half were malignant and half were not) (9). These adaptations enabled radiologists and urologists to render specific management recommendations: Bosniak I and II masses have been ignored, Bosniak IIF masses have been followed, and Bosniak III and IV masses historically have been treated unless substantial comorbidities or limited life expectancy would warrant observation instead (10-12).

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Three-year outcomes following renal cryoablation are encouraging. Longer term (5-year) data are necessary to determine the proper place of renal cryotherapy among minimally invasive, nephron sparing options.