Background: African American (AA) men suffer a higher prostate cancer (PCa) burden than other groups. Objective: We aim to determine the impact of race on the risk of upgrading, upstaging, and positive surgical margins (PSM) at radical prostatectomy (RP) among men eligible for active surveillance. Design, setting, and participants: We studied men with low-risk PCa treated with RP at two centers. Low clinical risk was defined by National Comprehensive Cancer Network criteria. Outcome variables were upgrading, upstaging, and PSMs at surgery. Associations between race and the outcomes were evaluated with logistic regression adjusted for age, relationship status, diagnostic prostate-specific antigen level, percentage of positive biopsy cores, surgical approach, year of diagnosis, and clinical site. Results and limitations: Of 9304 men diagnosed with PCa, 4231 were low risk and underwent RP within 1 yr. Men were categorized as AA (n = 273; 6.5%), Caucasian (n = 3771; 89.1%), or other racial/ethnic group (Other; n = 187; 4.4%). AA men had a significantly younger mean age (58.7 yr; standard deviation: AE7.06), and fewer (85%) were married or had a partner. Upgrading (34%) and upstaging (13%) rates did not significantly differ among the groups. The PSM rate was significantly higher in AA men (31%) than in the Caucasian (21%) and Other (20%) groups ( p < 0.01). We found an association between race group and PSM rate ( p < 0.03), with higher odds of PSMs in AA men versus Caucasian men (odds ratio [OR]: 1.64; 95% confidence interval [CI], 1.08-2.47). No statistically significant associations between race and rates of upgrading and upstaging were found. This study was limited by the relatively low proportion of AA men in the cohort. Conclusions: Among clinically low-risk men who underwent RP, AA men had a higher likelihood of PSMs compared with Caucasian men. We did not find statistically significantly different rates of upgrading and upstaging between the race groups. Patient summary: We analyzed two large groups of men with what appeared to be lowrisk prostate cancer based on the initial biopsy findings. The likelihood of finding worse disease (higher grade or stage) at the time of surgery was similar across different racial groups.

BackgroundEmphysematous pyelonephritis is a severe infection of the kidney associated with formation of gas in the renal parenchyma and/or collecting system. The purpose of this study was to evaluate outcomes of patients with emphysematous pyelonephritis in a contemporary cohort and to evaluate the impact of urolithiasis on disease severity.MethodsA search of all imaging reports at University of California San Francisco (UCSF) for the term “emphysematous pyelonephritis” was undertaken from 2003–2014. Patients were included if there was clinical evidence of infection, no recent urologic instrumentation, and computerized tomography (CT) demonstrating gas in the renal parenchyma or collecting system. Clinical and laboratory variables were obtained from medical records.ResultsA total of 14 cases were identified. The majority of patients (57%) had gas confined to the collecting system. Three patients (21%) had gas in the renal parenchyma and 3 patients (21%) had gas extending into perirenal tissues. A total of 8 patients (57%) had concomitant urolithiasis. Seven patients (50%) were managed with antibiotic therapy alone while 6 patients (43%) required percutaneous drainage. No patients required immediate nephrectomy. There were no deaths. Patients with urolithiasis had less severe emphysematous pyelonephritis than patients without urolithiasis (P<0.05).ConclusionsThe majority of patients in this study had gas contained within the collecting system and were treated successfully with antibiotics alone. Percutaneous drainage was successfully utilized in patients with more advanced disease. No patients required emergent nephrectomy. Emphysematous pyelonephritis in patients with urolithiasis was less severe than in patients without urolithiasis.

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INTRODUCTION:Rates of minimally invasive surgery are increasing relative to open surgery. We sought to compare the contemporary rates of short-term complications of open and laparoscopic renal surgery in pediatric patients. METHODS:A retrospective cross sectional analysis of the Pediatric NSQIP database was performed for all cases of partial and total nephrectomy reported in 2014. Cases were identified using ICD-9 procedure codes 50220, 50225, 50230, 50234, 50236, 50546, and 50548 for nephrectomy, and 50240 and 50543 for partial nephrectomy, and reviewed for postoperative complications. Univariate analysis was performed to determine risk factors for 30-day complications, with comparison between open and minimally invasive surgical approaches. RESULTS:Review identified 207 nephrectomies and 72 partial nephrectomies. Children undergoing laparoscopic nephrectomy were significantly older than those managed via open surgery (p ¼ 0.012), with a similar trend among partial nephrectomies (p ¼ 0.053). Children undergoing laparoscopic nephrectomy had greater body surface area than those treated by open surgery (p ¼ 0.004), but this difference was not significant among cases of partial nephrectomy (p ¼ 0.18). Operative time was significantly shorter for open vs laparoscopic nephrectomy (p < 0.001), but not for partial nephrectomy (p ¼ 0.8). Laparoscopic partial nephrectomies were associated with shorter length of stay relative to open surgery (p ¼ 0.001). There was no difference in all other 30-day complication rates measured.CONCLUSIONS: Minimally invasive pediatric renal surgery is associated with longer operative time for nephrectomy, but shorter length of stay after partial nephrectomy. Surgical approach was not found to impact short-term complications. Future cost-based analysis is warranted to better understand the optimal application of technology relative to patient care.