At short-term followup patients with renal cell carcinoma up-staged from cT1 to pT3a have reasonable oncological outcomes after partial nephrectomy. Factors associated with tumor up-staging include high tumor complexity, increasing tumor diameter and hilar location. Further studies are needed to determine the comparative efficacy of partial vs radical nephrectomy for small pT3a tumors.

Positive surgical margins on final pathological evaluation increase the HR of recurrence and metastasis. In addition to pathological and molecular tumor characteristics, this should be considered to plan appropriate management.

Background Urinary incontinence is a common short-term complication of radical prostatectomy (RP). Little is known about the long-term impact of RP on continence. Objective To elucidate the long-term progression of continence after RP. Design, setting, and participants From October 2000 through September 2012, 1788 men undergoing open RP for clinically localized prostate cancer by a single surgeon at an urban tertiary care center prospectively signed consent to be followed before RP and at 3, 6, 12, 24, 96, and 120 mo after RP. A consecutive sampling method was used and all men were included in this study. Intervention Men underwent open RP Outcome measurements and statistical analysis Regression models controlled for preoperative University of California, Los Angeles–Prostate Cancer Index urinary function score (UCLA-PCI-UFS), age, prostate-specific antigen level, Gleason score, stage, nerve-sparing status, race, and marital status were used to evaluate the association of time since RP with two dependent variables: UCLA-PCI-UFS and continence status. Results and limitation The mean UCLA-PCI-UFS declined between 2 yr and 8 yr (83.8 vs 81.8; p = 0.007) and marginally between 8 yr and 10 yr (81.8 vs 79.6; p = 0.036) after RP, whereas continence rate did not significantly change during these intervals. Men ≥60 yr old experienced a decline in mean UCLA-PCI-UFS between 2 yr and 8 yr (p = 0.002) and a marginal decline in continence rate between 2 yr and 10 yr (p = 0.047), whereas these variables did not change significantly in men <60 yr old. These outcomes are for an experienced surgeon, so caution should be exercised in generalizing these results. Conclusions Between 2 yr and 10 yr after RP, there were slight decreases in mean UCLA-PCIUFS and continence rates in this study. Men aged <60 yr had better long-term outcomes. These results provide realistic long-term continence expectations for men undergoing RP.

Objective-To assess the impact of the American Urological Association guidelines advocating partial nephrectomy for T1 tumors guidelines on the likelihood of undergoing partial nephrectomy.Materials and Methods-We analyzed the Nationwide Inpatient Sample, a dataset encompassing 20% of all United States inpatient hospitalizations, from 2007 through 2010. Our dependent variable was receipt of radical vs. partial nephrectomy (55.50, 55.51, 55.52, and 55.54 vs. 55.4) for a renal mass (ICD-9 code 189.0). The independent variable of interest was time of surgery (before or after the establishment of AUA guidelines); covariates included a diagnosis of chronic kidney disease (CKD), overall comorbidity, age, race, gender, geographic region, income, and hospital characteristics. Bivariate and multivariable adjusted logistic regression was used to determine the association between receipt of partial nephrectomy and time of guideline establishment. Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. Their data shows indeed an association between the increasing use of PN and the AUA guideline and a statistically significant increase in the likelihood of PN after AUA guideline publication. However association does not necessarily mean causality. In fact their study can neither rule-out the influence of other factors in the increasing use of PN nor exclude the logical implementation of a surgical technique. Furthermore, although statistically significant, the magnitude of the difference before and after AUA guideline publication is small and a net increment of 5% through 4 years might be considered marginally clinically relevant and similar to the increments described previously to the publication of the AUA guideline [3][4][5]. Results-We Conflicts of interest: NoneThese reflections do not discredit the value of the AUA guidelines for the Management of Renal Masses and the effort of Bjurlin and cols. On the contrary, this excellent document is more than adequate to improve process and structure of care and the present report opens a line of future investigation. It is likely that a longer period of time will be necessary to measure its effects on patients health outcomes otherwise scarcely studied [6]. Multiple barriers modulate the adherence to guidelines and there is a high level of variation in effects across recommendations [7].Guidelines on the other hand are not documents ahead of their time. More frequent than not, both technical implementation and development of comprehensive guidelines are parallel phenomena. Consequently a strong association is not strange but causality ...

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