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What's known on the subject? and What does the study add?• There is a paucity of population-based analyses of expected outcomes after renal surgery for kidney cancer. Reported blood transfusion rates after nephrectomy show considerable variability, probably as a result of the referral patterns that influence reports from tertiary academic medical centres.• With emerging data on the inferior outcomes in patients undergoing allogeneic blood transfusion, we aimed to evaluate the patient, surgeon and hospital factors that influence the receipt of a blood transfusion after nephrectomy. A more detailed understanding of these factors may help in preoperative patient counselling and informed consent. Objective• To examine blood transfusion rates after nephrectomy for renal masses at the population-level. Patients and Methods• We performed a population-based, retrospective observational study using a national discharge abstract database.• The study cohort consisted of 10 902 patients who were treated by radical nephrectomy (RN) or partial nephrectomy (PN) for a renal mass between 1 April 2003 and 31 March 2008.• The association between blood transfusion and various explanatory variables was examined using the chi-squared test and multivariable logistic regression. Results• The overall blood transfusion rate was 18.1%.• Transfusions occurred after 28.2%, 12.7%, 9.2% and 8.6% of open RN, open PN, laparoscopic RN and laparoscopic PN, respectively (P < 0.001).• Transfusion rates were found to be strongly associated with age and comorbidity, such that patients aged <50years with Charlson scores of 0 were transfused 11.2% and 14.5% of the time compared to 28.2% and 40.7% in patients aged Ն80 years with Charlson scores of Ն3, respectively (P < 0.001).• On multivariable logistic regression, age (P < 0.001),Charlson score (P < 0.001), procedure type (P < 0.001), surgeon (P < 0.001) and hospital volume quartile (P < 0.001) were all found to be associated with the rate of blood transfusions, whereas year of surgery, sex and income quintile were not. Conclusions• The transfusion rate after nephrectomy in general clinical practice is higher than that reported in the urological literature.• Patient and provider factors appear to contribute to the considerable variability that exists in the observed transfusion rate.• A more detailed understanding of these factors may help with respect to preoperative patient counselling and informed consent.

Transurethral resection of bladder tumor (TURBT) is the standard of care for initial bladder tumor management. In response to its shortcomings, we propose an alternative technique for tumor resection and retrieval: The endoscopic snare resection of bladder tumor (ESRBT). Eleven tumors managed by ESRBT were reviewed retrospectively. Via cystoscopy, tumors were resected en bloc with an electrosurgical polypectomy snare and retrieved transurethrally. Safety and efficacy were assessed by clinical and pathologic outcomes. ESRBT was highly effective for appropriate tumors. Tumor size and location varied: Two small, six medium, three large; six lateral wall, two dome, two trigone, one posterior wall. Half of initial urothelial carcinoma specimens contained muscle. There were no intraoperative or postoperative complications (mean follow-up: 17 mos; range 10-25 mos). ESRBT is a feasible technique for the resection of pedunculated bladder tumors. It offers evident and theoretical advantages over TURBT and may augment bladder tumor management. Further study is needed.