Karim Marzouk

Active surveillance (AS) is a widely established management strategy for low risk prostate cancer (Pca). An estimated 5-13% of patients terminate AS and undergo treatment due to cancer related anxiety. However, data on anxiety in this population is limited to traditional measures of general anxiety (e.g. ″I feel jittery″), rather than focusing on cancer specific anxiety (e.g. ″I′m worried about my cancer″). We present our findings from a large prospective cohort of men on AS.

Multiparametric Magnetic Resonance Imaging (mp-MRI) and the 4Kscore blood test (OPKO: Miami FL) have both been shown to identify significant prostate cancer in men with elevated PSA. In comparison to a blood test, mp-MRI is resource intensive, thus is difficult to apply at a population level. Moreover, results from the PROMIS MRI trial show that 11% of men with normal MRI harbor high-grade disease. One possibility is selective application of mp-MRI to men at intermediate risk as defined by the 4Kscore: this would reduce the number of MRIs and lower the chance of missed high-grade disease. The aim of this study was to evaluate mp-MRI as a follow-up test to the 4Kscore in prostate cancer early detection.

Patient reports of health related quality of life (HRQoL) are being used to facilitate understanding of the physical and psychological impacts of surgery in patients with bladder cancer. Presently, the true effect of radical cystectomy (RC) on female sexual function is poorly described. The aim of this study is to prospectively report baseline and post-operative sexual function in a group of females undergoing RC.

Surgical intervention is the standard of care for large renal masses; however patients with competing risks may not be suitable candidates for immediate intervention. This study illustrates our experience with active surveillance (AS) and expectant management of large renal masses (LRM) ≥ 4cm. We describe the growth rate of LRM under surveillance, factors associated with growth rate, and overall outcomes.

This is a case of a 68-year-old male who presented with a chief compliant of a testicular mass, which was discovered to be a metastatic lesion of undiagnosed renal cell carcinoma. A computed tomography scan revealed a large right renal mass and multiple pulmonary metastasis. Shortly after diagnosis, the patient was initiated on systemic therapy and received a cytoreductive nephrectomy. We discuss the details of this case as well as a pertinent review of metastatic renal cell carcinoma to the testes.

Background: Most studies have found cold ischemic time to be an important predictor of delayed graft function in kidney transplantation. Relatively less is known about the warm time associated with vascular anastomosis and early outcomes. Methods: A retrospective cohort of 298 consecutive solitary deceased donor kidney recipients from January 2006 to August 2012 was analyzed to examine the association between anastomosis time and delayed graft function (need for dialysis) and length of hospital stay. Results: Delayed graft function (DGF) was observed in 56 patients (18.8%). The median anastomosis time was 30 minutes (interquartile range 24, 45 minutes). Anastomosis time was independently associated with DGF in a multivariable, binary logistic regression analysis (odds Ratio (OR) 1.037 per minute, 95% CI 1.016, 1.057, P = 0.001). An anastomosis time >29 minutes was also associated with a 3.5 fold higher (OR 3.5, 95% CI 1.6, 7.3, P = 0.001) risk of DGF. Median days in hospital was 9 (interquartile range 7, 14 days). Every 5 minutes of longer anastomosis time (0.20 days per minute, 95% CI 0.13, 0.27, P 29 minutes was associated with 3.8 (95% CI 1.6, 6.0, P <0.001) more days in hospital. Conclusion: Anastomosis time may be an underappreciated but modifiable variable in dictating use of hospital resources. The impact of anastomosis time on longer term outcomes deserves further study.

Background: Given the unpredictable timing of deceased donor organs and the need for blood transfusion, this study was carried out to determine the rate and risk factors for transfusion in order to identifying a low-risk cohort in the face of a critical blood shortage. Methods: This retrospective chart review examined 306 consecutive deceased solitary kidney transplant recipients from January 2006 to August 2012. Results: Records show that 80 (26.1%) patients were transfused with a total of 300 units (0.98 units/transplant) during their first hospital stay. Transfusions were higher in patients on warfarin (8/14, 57%, 5.1 units/transplant) and antiplatelet agents (46/136, 33.8%, 1.1 unit/transplant) compared to no anticoagulants (74/156, 16.7%, 0.47 units/transplant). In a multivariable logistic regression analysis warfarin (odd ratio (OR) 8.2, 95% confidence interval (CI) 2.5–27, P=0.001), antiplatelet agents (OR 2.9, 95% CI 1.6–5.3, P=0.001), recipient age ≥55 years (OR 2.2, 95% CI 1.2–3.9, P=0.008), recipient male (OR 0.36, 95% CI 0.2–0.64, P=0.001) and preop hemoglobin ≥115 g/L (OR 0.32, 95% CI 0.18–0.57, P<0.001) were independent predictors of blood transfusion. Lower bleeding cohorts with transfusion rates <5% could not be identified. Conclusion: The need for blood is significantly higher in subjects on either warfarin or antiplatelet agents. These patients might be avoided if kidney transplantation is to occur during a critical blood shortage. Unfortunately even patients not on anticoagulation are at some risk.