Introduction: Placement of a ureteral stent at the time of renal transplantation can reduce complications when compared to non-stented anastomoses. Removal by flexible cystoscopy can be associated with discomfort, risk for infection, and high costs. New magnetic stents offer a means of bypassing cystoscopy by use of a magnetic retrieval device. Our objective was to compare clinical and cost-related outcomes of conventional and magnetic stents in patients undergoing deceased donor renal transplantation. Methods: Patients were randomized to receive either a conventional or a Black-Star® magnetic stent. Clinical, procedural, and cost outcomes were assessed, and the Ureteral Stent Symptom Questionnaire (USSQ) was administered with the stent in situ and after stent removal. All variables were compared between groups. Results: Forty-one patients were randomized to conventional (n=19) or Black-Star (n=22) stent. The total time for stent removal under cystoscopy was significantly longer compared to Black-Star removal (6.67±2.47 and 4.80±2.21 minutes, respectively; p=0.019). No differences were found in the USSQ domains between groups. Rates of urinary tract infections and surgical complications between groups were similar. Stent removal was well-tolerated in both groups. Black-Star stent use resulted in a cost savings of $304.02 Canadian dollars (CAD) per case. Conclusions: USSQ scores suggest that stent removal with the Black-Star magnetic stent is as equally well-tolerated as flexible cystoscopy by renal transplant patients. Black-Star stent removal was significantly faster than conventional stents. No differences in discomfort, infection rate, or complication rate were found. Use of the Black-Star stent resulted in an estimated annual savings of $27 360 CAD at our centre.

Horseshoe kidney is a congenital anomaly, which consists of fusion of the lower poles of the kidneys. Cancer in a horseshoe kidney is common, possibly because of the increased risk of chronic obstruction, renal calculi, and recurrent urinary infection. We report a case of a 64-year-old male with a horseshoe kidney who presented to our hospital with gross hematuria and flank pain, which was highly suggestive of pyelonephritis. Comprehensive workup and imaging were performed and showed an extremely rare form of tumor consisting of three histological variants: squamous, glandular, and sarcomatoid. To the best of our knowledge, this is the first case reported with these three histological variants in a horseshoe kidney.

Introduction: The objective of this study was to evaluate the safety and feasibility of using a polyethylene glycol (PEG)-coated collagen patch (Hemopatch®) in patients undergoing deceased donor renal transplant. The primary outcome was the amount of intraoperative estimated blood loss in those patients receiving the patch compared to without. Secondary outcomes were the subjective achievement of hemostasis, perigraft collection, and drop in hemoglobin 48 hours postoperatively. Methods: We performed a single-center, prospective, randomized trial. Patients scheduled to undergo deceased donor renal transplant surgery were randomized to receive the PEG-coated patch or standard hemostasis (i.e., electrocautery and clips). Results: A total of 30 patients were enrolled over 15 months and randomized to receive the PEG-coated patch (n=15) or standard hemostasis (n=15). The mean age was 62.5 years. As determined by the operating surgeon, hemostasis was successfully achieved in all 15 cases using the PEG-coated patch. In the PEG-coated patch group, there was a trend towards less estimated blood loss (237 cc vs. 327 cc; p=0.11) and a lower drop in hemoglobin 48 hours postoperatively (22.27 g/L vs. 29.53 g/L; p=0.09) compared to the standard hemostasis group. Perigraft collection was similar between groups (27% vs. 40%; p=0.43). Subgroup analysis on patients who received anticoagulation therapy revealed no significant difference in blood loss between groups. Conclusions: Based on our single-center experience, the PEG-coated patch (Hemopatch®) is a safe and feasible option to aid hemostasis during deceased donor renal transplant surgery. Hemostasis was successfully achieved in all cases using the PEG-coated patch.

Renal cell carcinoma accounts for about 2% of all adult malignancies. More than 300,000 individuals are affected each year. Unfortunately, around 30% of cases are discovered in advanced stages. Surgical resection remains the mainstay of treatment for localized disease and relapses can reach up to 40% in some cases. The effective treatment of metastatic RCC with systemic targeted therapy gives a strong rationale for its use as adjuvant treatment in high-risk patients. This chapter reviews different modalities that have been used as an adjuvant therapy for nonmetastatic renal cancer. Clinical trials using targeted therapy are discussed in detail, as they are becoming options for treatment in high-risk patients. While the current set of completed adjuvant clinical trials have provided conflicting results, there are additional large-scale trials that are still in progress. Future directions include-incorporating a genetic recurrence score to evaluate risk of relapse in patients, developing an adequate and an objective standardized adjuvant trial design, identifying novel biomarkers, and evaluating novel drug targets. Based upon current clinical trial evidence, motivated high-risk patients should have a discussion with the urology oncology team regarding the benefits of adjuvant TKI sunitinib or consider enrollment in current ongoing immuno-oncology (IO) adjuvant clinical trials.

We reviewed 103 patients who underwent RA from 2004 to 2017. Satisfactory outcome (SO) was defined as post-operative patent vasculature on ultrasound and/ or normal nuclear scan. Unsatisfactory outcomes (UO) included Compromised grafts (CG) (partial infarction on radiographic studies more than 20%) and lost grafts (LG) (nephrectomy or absent perfusion on radiographic studies).RESULTS: Median age was 39 years (IQR: 32-47). Females were 71 (69%) and males were 32 (31%). Median follow up time was 9.5 months (IQR: 2.5-30) Indications for RA were renovascular diseases (n¼27), Ureteric pathology (n¼30), intractable nephrolithiasis (n¼30), flank pain (n¼ 15) and pancreatic neoplasm (n¼1). 89 (86.4%) patients had a SO while 14 (13.6%) had a UO (CG¼ 7, LG¼ 7). There was no statistically significant difference between UO and SO in median preoperative creatinine (p¼0.2), preoperative positive urine culture (p¼0.32), history of stone disease (P¼0.27) and prior urinary tract instrumentation (p¼0.11). However, presence of ureteric stent or nephrostomy tube (PCN) at time of RA was significantly higher in UO (42.9% vs. 16.9%, p¼0.04). Also, multiple arterial anastomoses were more frequent in UO (42.9% vs 18.2%, p¼0.03). Other operative variables including median blood loss (p¼0.23) and type of urinary reconstruction (p¼0.6) were not significantly different. Median creatinine at last follow up was higher in UO compared to SO (1.08 mg/dl vs 0.86 mg/ dl, p¼ 0.005). On logistic regression model, the presence of a stent or PCN at time of surgery (OR 4.19, 95% CI 1.2-14.71, p¼0.03) and multiple arterial anastomoses (OR 3.89, p¼0.03) were independent predictors of UO.CONCLUSIONS: The presence of a stent or PCN at time of surgery and multiple arterial anastomoses were associated with graft compromise or loss. While the correlation between number of arteries and outcomes is sound, the stronger correlation of stents and PCN at time of surgery with worse outcomes is unclear. Our hypothesis is that ureteric stents and PCNs harbor infections despite appropriate antibiotic treatment. Consequently, these kidneys are more prone to technical failure after RA suggesting the need for an alternative approach with respect to those indwelling devices.