Journal of Clinical Urology

We report a tertiary referral centre's experience of cytoreductive nephrectomy (CN) combined with immunotherapy as part of multimodality treatment for metastatic renal cell cancer (mRCC) over a period of 8 years.

Patients who underwent CN as part of multimodality treatment for mRCC were identified from our nephrectomy database. Demographic characteristics, oncological outcome, reasons for failure to start or to complete immunotherapy, pathological findings and a comparison between open and laparo-scopic CN were evaluated.

Forty patients underwent CN for mRCC preceding immunotherapy. 26 (65%) failed to receive immunotherapy. This was most commonly due to poor performance status postoperatively (12/26, 46%). 14 patients (35%) received immunotherapy following surgery and 9 (23%) patients completed treatment. Laparoscopic CN was associated with a significantly lower blood loss, shorter hospital stay and lower rate of transfusion than the open approach.

Patients are at significant risk of failure to proceed to adjuvant immunotherapy following CN for mRCC, most commonly due to poor performance status postoperatively. Laparoscopic CN is shown to be safe and effective in well-selected patients. As new targeted treatments for mRCC emerge and their use in combination with CN is evaluated, a detailed and multidisciplinary approach to selection of these patients will continue to be crucial.

To assess our success rate for laparoscopic pyeloplasty using various definitions reported in the literature.

Data for 52 patients undergoing transperitoneal laparoscopic pyeloplasty were retrospectively analysed. We define success as improvement in pain plus preservation of differential function on MAG3 renogram. Other case series were identified in the literature and their definitions of success used to reassess our data.

Full data were available on 47/52 patients. Defining success as improvement in pain plus preservation of differential function on MAG3 renogram, our success rate was 85.1%. By entering our data into others' definitions of success, our success rate ranged from 77% to 98%.

We have demonstrated the impact of various definitions on the reported success rate in laparoscopic pyeloplasty. There is a need for consensus in defining success so that meaningful comparison of results can be made. We propose that our definition should be adopted in future assessments of this procedure.

To prospectively compare the performance of voided urine cytology (VUC) and the Matritech NMP22 BladderChek® assay (NMP22) in their ability to detect urothelial transitional cell carcinoma (TCC).

Successive patients presenting to our haematuria clinic were enrolled. All patients underwent ultrasound scan (US), intravenous urography (IVU), flexible cystoscopy and VUC. If bladder TCC was detected, urine was tested using the NMP22 BladderChek® assay. The study group (group I) comprised 110 patients diagnosed with bladder tumour on flexible cystoscopy. The control group (group II) included 52 patients with a history of haematuria but no demonstrable bladder tumour. The TCC detecting ability of both the NMP22 BladderChek® assay and VUC were compared.

In group I, the NMP22 result was positive in 62.7% (69/110) patients, while a positive VUC result was noted in 52.0% (52/100) patients. The overall sensitivity, specificity, positive predictive and negative predictive values for NMP22 vs. VUC were 62.7% vs. 52.0%; 86.5% vs. 95.5%; 90.8% vs. 96.3% and 52.3% vs. 48.0% respectively (not significant). The performance of both urine tests improved with increasing tumour grade (p ≤ 0.05). False positive rate in group II was 13.5% (7/52) for NMP22 and 4.5% (2/42) for VUC.

The diagnostic accuracy of the NMP22 BladderChek® assay for TCC detection is equivalent to conventional VUC, but the NMP22 BladderChek® has distinct advantages to promote its use over VUC.