Renal pseudoaneurysm is a rare vascular lesion that arises when an arterial injury within the kidney leads to contained hemorrhage. The associated hematoma forms outside the arterial wall and is typically surrounded by a layer of fibrous inflammatory tissue and blood clot. These lesions are unstable and their rupture can lead to life-threatening hemorrhage. Renal pseudoaneurysm has been reported to occur in various clinical scenarios, including after renal trauma, surgery and percutaneous procedures, as well as inflammatory and neoplastic processes within the kidney. Endovascular selective angioembolization is the mainstay of treatment, although surgery might be indicated when hemostasis and repair of the arterial wall defect are required. Percutaneous ultrasound-guided embolization is an additional option for patients with unfavorable vascular anatomy, or who cannot tolerate or have contraindications to the use of intravenous contrast agents. Some evidence suggests that these lesions can regress without intervention, although observation alone is not recommended as a management strategy in the vast majority of patients owing to the high risk of rupture. Evaluation and management of patients with renal pseudoaneurysm must take into account each individual's circumstances, due to the difficulty of accurately predicting the probability of spontaneous resolution or rupture.

Background Prostate cancer arises in the transition zone (TZ) in approximately 20-25% of cases. Modern biopsy and surveillance protocols, and advances in prostate cancer imaging, have renewed interest in TZ prostate cancers. We compared TZ and PZ prostate cancer to determine if cancer location is independently associated with better outcomes. Methods We evaluated an expanded cohort of 1534 men who underwent radical prostatectomy between 1983 and 2003 with updated long-term clinical follow-up. Regression models were used to compare the volume of high-grade (Gleason 4 or 5) cancer and total cancer volume by location. Uni- and multi-variable logistic regression models tested the associations between cancer location and adverse pathologic features. Multivariable proportional hazard models were fit to examine cancer recurrence. Results Patients with TZ cancer presented with higher pre-operative serum PSA values (11.07 versus 7.86 ng/mL) and larger total cancer volume (7.1 versus 3.8 cc). Patients with TZ cancer had decreased odds of seminal vesicle invasion (OR 0.08, 95%CI 0.03, 0.21), extra-capsular extension (OR 0.56, 95%CI 0.35,0.92), and lymphovascular invasion (OR 0.48, 95%CI 0.27, 0.87) in multivariable models. TZ cancers were independently associated with decreased hazard of tumor recurrence (HR 0.62, 95%CI 0.43, 0.90). Conclusions TZ cancer prostate is associated with favorable pathologic features and better recurrence-free survival despite being diagnosed with larger cancers and higher PSA values. Tumor location should be taken into account when stratifying patient risk before and after prostatectomy, particularly with the evolving role of imaging in prostate cancer management.

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