Results from this study show a ratio of 1.65 of renal cell carcinoma for males compared to females. Women are more likely than men to have stage I tumors. Both men and women have demonstrated stage migration, although women more so than men.

What's known on the subject? and What does the study add?• Treatment options for small renal masses include radical nephrectomy (RN), and nephron sparing modalities (NSM) such as partial nephrectomy (PN), and thermal ablation (Cryo-and radiofrequency ablation, C/RFA). Prior studies had demonstrated gross underutilization of PN; however overall treatment trends for C/RFA had not been well studied using a population-based cohort. In this study, which examined management trends of localized renal masses in the USA, we identified an increased prevalence of RN, PN and C/RFA over the study period, with PN increasing the most rapidly, and with RN continuing to account for the vast majority of procedures.• This is the first study to examine surgical management of renal masses in patients with non-dialysis dependent chronic renal insufficiency. Although nephron sparing modalities were increasingly utilized over the study period, it is particularly concerning that patients with pre-existing non-dialysis dependent chronic renal insufficiency are receiving less nephron sparing approaches. Further investigations are required to confirm these findings and to identify impediments to the dissemination of nephron sparing modalities. Objective• To evaluate the diffusion of nephron-sparing modalities (NSM) for the treatment of renal neoplasms in the USA over the last decade and to identify the factors associated with renal procedure selection. Patients and Methods• The Nationwide Inpatient Sample was utlized to identify patients undergoing cryo/radiofrequency ablation (C/RFA), radical nephrectomy (RN) and partial nephrectomy (PN) from 1998 to 2008. • Annual trends in procedure prevalence were determined.• Multivariate analyses were performed to query the influence of age, race, sex and comorbid disease on surgery selection. Results• We identified 443 853 procedures performed during the study period: 25 599 C/RFA, 79 568 PN and 338 687 RN.• The prevalence per 100 000 hospital admissions in 1998 was 3.7 for C/RFA, nine for PN and 87.1 for RN. All procedures increased over the study period, by 1.05, 3.1 and 2.2/100 000 admissions per year, respectively (all P < 0.001).• Diabetes, urban, teaching and large capacity hospitals were associated with NSM (either C/RFA or PN) compared to RN (all P Յ 0.011). Age Ն70 years, female, hypertension, diabetes, chronic kidney disease (CKD) and region outside the Northeast favoured C/RFA over PN (all P Յ 0.026).• Compared to those without CKD, patients with CKD had an almost twofold higher probability of undergoing RN than NSM (odds ratio, 1.88; 95% confidence interval, 1.7-2.1). Despite increasing NSM utilization over the study period, most patients with CKD still received RN. Conclusions• Although the prevalence of NSM is increasing, RN is more common.• The low utilization of NSM in patients with pre-existing CKD warrants further investigation.

0 9What ' s known on the subject? and What does the study add? The consequences and signifi cance of iatrogenically-induced CKD are poorly understood. Most data regarding risk of CKD and its complications are inferred from the medical literature. This is the fi rst study to examine impact of surgical management of renal masses on development of anaemia. Patients who underwent radical nephrectomy had a signifi cantly higher incidence of anaemia and ESA utilization than a contemporary well-matched cohort that underwent partial nephrectomy. The results obtained add to the growing body of data supporting the use of partial nephrectomy in the management of clinically appropriate renal masses. OBJECTIVE• To examine the incidence of and risk factors for the development of anaemia and erythropoiesis-stimulation agent (ESA) treatment in patients undergoing radical nephrectomy (RN) and partial nephrectomy (PN) because anaemia is a signifi cant cause of morbidity in chronic kidney disease. PATIENTS AND METHODS• The study comprised a retrospective review of 905 patients (610 RN/295 PN; mean age, 57.5 years; mean follow-up, 6.4 years) who underwent surgery for renal tumours at two institutions from July 1987 to June 2007.• Demographics, disease characteristics and pre-and postoperative (i.e. renal function, metabolic parameters, anaemia and ESA treatment) were recorded.• Data were analyzed within subgroups based on treatment (RN vs PN).• Multivariate analysis was conducted to determine the risk factors for developing anaemia after surgery. RESULTS• Tumour size (cm) was signifi cantly larger for RN (RN 7.0 vs PN 3.7; P < 0.001). No signifi cant differences were noted with respect to demographics and preoperative anaemia (RN 16.4% vs PN 18.6%; P = 0.454) and ESA-treatment (RN 0.7% vs PN 1.4%; P = 0.499).• After surgery, signifi cantly less de novo anaemia (PN 4.1% vs RN 17.5%; P < 0.001) and ESA utilization (PN 2.7% vs RN 13.4%; P < 0.001) occurred in the PN cohort.• Multivariate analysis showed that age ≥ 60 years (odds ratio, OR, 1.62; P = 0.008), African American ethnicity (OR, 2.30; P < 0.001), smoking (OR, 1.60; P = 0.013), glomerular fi ltration rate (GFR) < 60 mL/ min/1.73 m 2 (OR, 4.09; P < 0.001), ≥ 1 + proteinuria (OR, 2.19; P < 0.03), metabolic acidosis (OR, 4.08; P = 0.007) and RN (OR, 2.58; P < 0.001) were signifi cantly associated with de novo anaemia. CONCLUSIONS• Patients who underwent RN had a signifi cantly higher prevalence of anaemia and ESA-treatment compared to a well-matched cohort that underwent PN.• In addition to RN, age ≥ 60 years, African American ethnicity, history of smoking, GFR < 60 mL/min/1.73 m 2 , proteinuria and metabolic acidosis were associated with developing anaemia.

The aim of this study is to evaluate the outcomes of robot-assisted laparoscopic prostatectomy (RALP) in prostate cancer (PCa) patients with human immunodeficiency virus (HIV). This is a prospective cohort study of HIV patients undergoing RALP, comparing the demographics, tumor characteristics, complications, and short-term oncological outcomes of HIV-positive men to HIV-negative men using univariate (v 2 , Mann-Whitney test) and multivariable (logistic regression) analyses. From 2007 to 2010, 298 men underwent RALP, 8 of whom were known to be HIV positive. Preoperatively, all eight were taking highly active antiretroviral therapy (HAART) and had undetectable viral loads (o50); mean CD4 count was 634 cells per mm 3 . HIV-positive men were younger (54 versus 62 years, P ¼ 0.010) and less likely to be white (P ¼ 0.007). There were no significant differences between groups with respect to clinical staging, pathological and oncological outcomes or most complication rates. However, the prevalence of perioperative transfusions (P ¼ 0.031) and ileus (P ¼ 0.021) were higher in HIV-positive patients. HIV remained significantly associated with risk of transfusion after adjustment for age, race, Gleason sum and clinical T stage (P ¼ 0.002). After a median of 2.6 (range 0.03-19.2) months of follow-up, PSA remained undetectable in all eight HIV patients. These data suggest that RALP is safe for, and demonstrates short-term oncological efficacy in, HIV-positive patients with PCa.