Robert S Figenshau

Washington University in St. Louis | WUSTL , Wash U

Background We present the first report comparing early toxicity outcomes with high-dose rate brachytherapy (HDR-BT) boost upfront versus intensity modulated RT (IMRT) upfront combined with androgen deprivation therapy (ADT) as definitive management for intermediate risk or higher prostate cancer. Methods and Materials We reviewed all non-metastati...

Objective To use a randomized, prospective, multi-institutional study to compare the safety and efficacy of conventional insufflation (CIS) and valveless insufflation (AirSeal Insufflation – AIS) at the conventional pressure of 15 mmHg in robot-assisted partial nephrectomy – a surgery where AIS has gained popularity for maintaining visualization de...

Background Combination checkpoint inhibitor immunotherapy has recently become a new frontline standard of care for metastatic renal cell carcinoma (mRCC). Previously published data has demonstrated a survival benefit of cytoreductive nephrectomy (CN) in the interferon era, but the utility of CN in conjunction with the use of tyrosine kinase inhibit...

Background: The decision to perform a partial nephrectomy (PN) relies largely upon the complexity of the renal mass and its surrounding anatomy. The presence of adherent perinephric fat (APF) can increase surgical complexity and extend operative times. The accurate prediction of APF may improve surgical planning and aid in decision making for the...

We describe the rare case of a 61-year-old female with right ureteropelvic junction (UPJ) obstruction caused by metastatic cholangiocarcinoma. Her past medical history was notable for cholangiocarcinoma treated with neoadjuvant chemoradiation and two orthotopic liver transplants six years earlier. Urology was consulted when she presented with flank...

Background Local‐regional failure (LF) for locally advanced bladder cancer (LABC) after radical cystectomy (RC) is common even with chemotherapy and is associated with high morbidity/mortality. Postoperative radiotherapy (PORT) can reduce LF and may enhance overall survival (OS) but has no defined role. We hypothesized that the addition of PORT wou...

Introduction: Squamous cell carcinoma (SqCC) is the second most common histology of primary bladder cancer, but still very limited information is known about its treatment outcomes. Most bladder cancer trials have excluded SqCC, and the current treatment paradigm for localized SqCC is extrapolated from results in urothelial carcinoma (UC). In part...

Hypertriglyceridemia is an independent risk factor for cardiovascular disease. Dietary interventions based on protein restriction (PR) reduce circulating triglycerides (TGs), but underlying mechanisms and clinical relevance remain unclear. Here, we show that 1 week of a protein-free diet without enforced calorie restriction significantly lowered ci...

Since its introduction in 2004 by Gettman and colleagues [1], robot-assisted partial nephrectomy (RAPN) has been steadily gaining acceptance as part of a new standard of care for the treatment of localized renal malignancy. However, this rise to prominence has not been without its share of difficulties.

484 Background: Local-regional failure (LF) for locally advanced bladder cancer (LABC) after radical cystectomy (RC) is common even with chemo and is associated with high morbidity/mortality. Adjuvant radiotherapy (adjRT) can reduce LF and may enhance overall survival (OS) but has no defined role. We hypothesized that the addition of adjRT would im...

Objectives To provide a training tool to address the technical challenges of robot-assisted laparoscopic partial nephrectomy, we created silicone renal tumor models using 3D printed molds of a patient's kidney with a mass. In this study, we assessed the face, content, and construct validity of these models. Materials and Methods Surgeons of differe...

OBJECTIVES/SPECIFIC AIMS: More partial nephrectomies are performed every year as a surgical treatment for kidney cancer. However, this procedure remains technically challenging. Surgeons require a substantial number of cases before their performance plateaus. No established practice mode exists; thus, there is a need for training models to simulate...

Treatment modalities for small renal masses (SRMs) include open or minimally invasive radical or partial nephrectomy, and laparoscopic or percutaneous ablations. Members of the Endourological Society were surveyed to evaluate how practitioner and clinical practice characteristics may be associated with the management of SRMs over time. The survey a...

Background: The aim of this study was to investigate the incidence of benign histology after partial nephrectomy (PN) in patients with presumed malignancy from preoperative imaging. Further, preoperative predictors of benign lesions and perioperative outcomes were also assessed. Methods: A series of patients undergoing PN for renal masses was id...

Lymphoepithelioma-like carcinoma (LELC) is a rare finding in the upper urinary tract. The presenting clinical findings mimic those of other more common upper-tract tumors, such as urothelial carcinoma. Preoperative imaging has not been shown to reliably predict the diagnosis of LELC. This tumor can be misdiagnosed as a reactive inflammatory lesion...

Introduction: Approximately 5% of angiomyolipomas (AMLs) are classified as "fat poor" due to lack of visually detectable fat on imaging, making them difficult to distinguish from renal cell carcinoma. Recent investigations have proposed computed tomography (CT) and magnetic resonance (MR) imaging features suggestive of fat-poor AML (fp-AML). Herei...

The objective of this study was to evaluate surgical outcomes with respect to the experience level of the bedside assistant during robot-assisted partial nephrectomy. A retrospective review was conducted of a prospectively maintained database of 414 consecutive robot-assisted laparoscopic partial nephrectomies performed by experienced robotic surge...

Background Since there is still an unmet need for potent adjuvant strategies for renal cancer patients with high progression risk after surgery, several targeted therapies are currently evaluated in this setting. We analyzed whether inclusion criteria of contemporary trials (ARISER, ASSURE, SORCE, EVEREST, PROTECT, S-TRAC, ATLAS) correctly identify...

497 Background: The decision to perform a partial nephrectomy (PN) relies largely upon the complexity of the renal mass and its surrounding anatomy. An often encountered intraoperative challenge in PN is the adherent perinephric fat (APF). The anticipation of this feature may improve preoperative risk assessment and aid in decision-making for the s...

Granulosa cell tumors (GCTs) of the testis are rare sex cord-stromal tumors that are present in both juvenile and adult subtypes. While most adult GCTs are benign, those that present with distant metastases manifest a grave prognosis. Treatments for aggressive GCTs are not well established. Options that have been employed in previous cases include...

Objective: To identify specific comorbidities within the Charlson Comorbidity Index (CCI) that are associated with increased complication rates after robotic-assisted partial nephrectomy (RAPN). Patients and methods: After IRB approval, a consecutive series of 641 patients undergoing RAPN was retrospectively identified. Perioperative complicatio...

Purpose: To compare perioperative outcomes, specifically hospital length of stay (LOS), after retroperitoneal and conventional transperitoneal robot-assisted partial nephrectomy (RAPN). Patients and methods: We retrospectively compared consecutive patients with a posterior renal mass undergoing retroperitoneal RAPN (n=116) versus transperitoneal...

The current TNM system for renal cell carcinoma (RCC) merges perirenal fat invasion (PFI) and renal vein invasion (RVI) as stage pT3a despite limited evidence concerning their prognostic equivalence. In addition, the prognostic value of PFI compared to pT1-pT2 tumors remains controversial. To analyze the prognostic significance of PFI, RVI, and tum...

To evaluate the sensitivity and specificity of urine aquaporin 1 (AQP1) and perilipin 2 (PLIN2) concentrations to diagnose clear cell or papillary renal cell carcinoma (RCC) by comparing urine concentrations of these unique biomarkers in patients with RCC, noncancer renal masses, bladder cancer, and prostate cancer. From February 1, 2012, through O...

The incidence of renal cell carcinoma continues to increase with utilization of diagnostic abdominal imaging with migration towards a proportionally greater detection of small renal masses (SRM). Robot-assisted partial nephrectomy (RAPN) has become an attractive minimally invasive treatment modality for SRM's due to the technical advantages and sho...

We report a case of a 17-year-old girl with tuberous sclerosis complex who underwent partial nephrectomy for a newly discovered 7.5-cm renal mass subsequently determined to be an epithelioid angiomyolipoma, a rare variant of angiomyolipoma that can be confused clinically, radiographically, and pathologically for renal cell carcinoma. Proper diagnos...

Objectives: To analyze clinicopathological features and survival of surgically treated patients with renal cell carcinoma (RCC) ≥ 80 years of age in comparison with patients between the ages of 60 and 70 years. Materials and methods: The data for 2,516 patients with a median follow-up of 57 months were retrieved from a multinational database (Co...

Objective: To determine if patients with pathological, medical renal disease, defined as evidence of pathological abnormalities indicative of renal damage in the non-neoplastic partial nephrectomy specimens, have worsened functional outcomes following robot-assisted partial nephrectomy (RPN). Materials and methods: Sixty patients with and 101 wi...

Pheochromocytomas are rare neuroendocrine tumors. Although predominantly occurring in the adrenal glands, these tumors can present anywhere along the sympathetic chain. Indeed, classical teaching states that 10% of pheochromocytomas are extra-adrenal and 10% are malignant. We report a case of a 61-year-old female who underwent presumptive cytoreduc...

Objective To compare perioperative and oncologic outcomes between laparoscopic (LCA) and percutaneous cryoablation (PCA) and identify predictors of treatment failure after cryoablation. Methods Retrospective analysis was performed on 145 patients undergoing LCA and 118 patients undergoing PCA at our institution between July 2000 and June 2011. Re...

Port site metastasis (PSM) is a rare occurrence following minimally invasive treatment for renal cell carcinoma (RCC). However, its prognostic implications are unclear because reports in the literature are heterogeneous in detail and follow-up. We sought to clarify the significance of PSM on cancer-specific survival and broaden our understanding of...

Der chromophobe Subtyp (chNZK) stellt die dritthäufigste histologische Variante des Nierenzellkarzinoms (NZK) dar. Aufgrund der relativen Seltenheit dieses Subtyps liegt derzeit nur eine Arbeit vor, die eine gezielte Analyse der klinischen und histopathologischen Kriterien sowie des Überlebens von mehr als 200 Patienten mit chNZK leistet.Die Datenb...

To evaluate the effects of a reverse thermosensitive polymer during ureteroscopy with laser lithotripsy in an in-vivo porcine model. Six pigs underwent general anesthesia followed by bilateral ureteroscopy with laser lithotripsy of stone phantoms while measuring intrapelvic renal pressures through bilateral nephrostomy tubes. The procedures were pe...

Background and Purpose: AUA guidelines endorse partial nephrectomy as the preferred treatment for small renal masses, while considering patients with significant comorbidities potential candidates for ablative therapy. We compared perioperative, renal functional, and oncological outcomes of renal cryoablation and robot-assisted partial nephrectomy...

To evaluate the trends in urine aquaporin-1 (AQP1) and perilipin 2 (PLIN2) concentrations in patients with clear cell and papillary renal cell carcinoma (RCC), we determined the relationship between the urine concentration of these biomarkers and tumor size, grade, and stage. The biomarker concentrations were determined by sensitive and specific We...

Retrieval of foreign bodies from the genitourinary system, most commonly inserted for sexual satisfaction or as a result of a psychiatric illness, can pose a significant surgical challenge. Due to their breadth of size, shape, and location within the genitourinary system, endoscopic management can be difficult. Here, we review the management of fou...

To analyze distinct clinico-pathological features and prognosis of patients with renal cell carcinoma aged =40 years in comparison to a reference group of patients aged 60-70 years. Overall 2.572 patients retrieved from a multi-center international database comprising of 6.234 patients with surgically treated renal cell carcinoma were included in t...

Background: The chromophobe subtype represents the third most common histological subtype of renal cell carcinoma (chRCC). Due to the rarity of this subtype only one publication regarding the specific analysis of clinical and histopathological criteria as well as survival analysis of more than 200 patients with chRCC is known to date. Materials a...

Purpose To investigate gender differences in clinicopathological features and to analyze the prognostic impact of gender in renal cell carcinoma (RCC) patients undergoing surgery. Methods A total of 6,234 patients (eleven centers; Europe and USA) treated by radical or partial nephrectomy were included in this retrospective study (median follow-u...

Technique, Outcomes, and Evolving Role of Extirpative Laparoscopic and Robotic Surgery for Renal Cell Carcinoma Youssef S. Tanagho, R. Sherburne Figenshau, and Sam B. Bhayani This article provides an overview of extirpative laparoscopic and robotic procedures used in the management of renal cell carcinoma, including laparoscopic radical nephrectomy...

Background and purpose: Port-site metastasis (PSM) is a rare complication of laparoscopic intervention in urologic malignancies. Of the greater than 50 reported cases of PSM in the urologic oncology literature, only 9 have occurred after surgery for renal-cell carcinoma (RCC). We report a 10th instance of RCC metastasis-in this case to the camera-...

Purpose: To provide a summary of the relevant literature regarding the impact of surgical cyst decortication on hypertension, renal function, and pain management in patients with autosomal dominant polycystic kidney disease (ADPKD). Methods: Data collection was conducted via a Medline search using the subject headings autosomal dominant polycyst...

Unlabelled: WHAT'S KNOWN ON THE SUBJECT? AND WHAT DOES THE STUDY ADD?: For patients who are unfit for extirpative surgery, percutaneous cryoablation (PCA) presents a minimally-invasive alternative for the treatment of renal masses. PCA has been demonstrated to be safe, with complication rates <10% being reported consistently. Studies have suggeste...

Abstract Robot-assisted partial nephrectomy (RAPN) has been established as a viable alternative to open and laparoscopic partial nephrectomy for small renal tumors. Multiple variations in surgical technique have been described to reduce warm ischemia time (WIT). We present our off-clamp technique for RAPN. From August 2007 to January 2012, off-clam...

To evaluate the potential benefit of performing off-clamp robot-assisted partial nephrectomy as it relates to renal functional outcomes, while assessing the safety profile of this unconventional surgical approach. Twenty-nine patients who underwent off-clamp robot-assisted partial nephrectomy for suspected renal cell carcinoma at Washington Univers...

We elucidate the role of endopyelotomy as a primary and secondary intervention for ureteropelvic junction obstruction in children. We retrospectively identified 79 pediatric patients who underwent endopyelotomy for ureteropelvic junction obstruction between 1986 and 2011. Eleven patients were lost to followup and were excluded from analysis. Patien...

Cyst proliferation in patients with autosomal dominant polycystic kidney disease is associated with renal failure, hypertension and pain. We examined the long-term impact of laparoscopic cyst decortication on renal function, hypertension and pain control in patients with adult dominant polycystic kidney disease presenting with refractory pain. Betw...

To evaluate perioperative and long-term functional and oncological outcomes of laparoscopic cryoablation (LCA) performed at Washington University. A retrospective chart review was performed evaluating 62 consecutive patients who underwent LCA at our institution between 2000 and 2005. Mean age-adjusted Charlson Comorbidity Index (CCI) was 6.1 (SD, 2...

Considering the potential impact of warm ischemia time (WIT) on renal functional outcomes after robot-assisted partial nephrectomy (RAPN), many techniques that reduce or eliminate WIT have been studied. We present our institutional experience and progression using one such technique-off-clamp RAPN-as well as the results of this technique in the man...

Introduction: Posterior upper-pole renal masses are arguably among the most challenging to address in a minimally invasive fashion.¹ In the accompanying video, we demonstrate our technique for minimally invasive partial nephrectomy via a retroperitoneal approach for these uniquely challenging cases, along with an overview of our results utilizing t...

Background and purpose: Because of the impact warm ischemia time may have on renal function, various surgical techniques have been proposed to minimize or eliminate warm ischemia. The purpose of this study is to evaluate our initial renal functional outcomes of off-clamp robot-assisted partial nephrectomy (RAPN), while assessing the safety profile...

Despite the explicit endorsement of the American Urological Association guidelines of partial nephrectomy as the treatment of choice for T1a renal cell carcinoma, a considerable underuse of nephron sparing surgery characterizes general practice patterns in the United States. We explored possible financial disincentives associated with partial nephr...

The adoption of robotic assistance has contributed to the increased utilization of partial nephrectomy for the management of renal tumors. However, partial nephrectomy can be technically challenging because of intraoperative hemorrhage, which limits the ability to identify the tumor margin and may necessitate the conversion to open surgery or radic...

Robotic Pyeloplasty (RAP) is a technique for management of ureteropelvic junction obstruction (UPJO). To report outcomes of RAP for primary and secondary (after failed primary treatment) UPJO. Single institution data of adult RAP performed from 2007 to 2009 was collected retrospectively following approval by our IRB. Database analysis included pati...

Laparoscopic renal surgery is associated with reduced blood loss, shorter hospital stay, enhanced cosmesis, and more rapid convalescence relative to open renal surgery. Laparoscopic partial nephrectomy (LPN) is a minimally invasive, nephron-sparing alternative to laparoscopic radical nephrectomy (RN) for the management of small renal masses. While...

We compared laparoscopic and robotic pyeloplasty to identify factors associated with procedural efficacy. We conducted a retrospective multicenter trial incorporating 865 cases from 15 centers. We collected perioperative data including anatomical and procedural factors. Failure was defined subjectively as pain that was unchanged or worse per medica...

Purpose: Dismembered pyeloplasty is the gold standard treatment for ureteropelvic junction obstruction (UPJO). Pure or robotic laparoscopic pyeloplasty are accepted minimally invasive surgical approaches. The least invasive treatment of UPJO is endopyelotomy. We evaluate our experience with endopyelotomy in pediatric patients. Methods: We retrosp...

At present, open retroperitoneal lymph node dissection (RPLND) remains the preferred approach at many high-volume centers for the surgical treatment of patients with low-stage testis cancer. Despite the potential advantages of a minimally invasive approach, including improved cosmesis and shorter recovery times, there remain concerns over the quali...

Study Type – Therapy (case series) Level of Evidence 4 What's known on the subject? and What does the study add? Although nephron-sparing surgery (NSS) has became accepted therapy for T1 tumours, radical nephrectony is considered the best therapy for T3a tumours involving the renal vein. NSS can be considered in T3a or greater tumours if imperative...

To examine the outcomes of patients with a positive surgical margin by gross and/or frozen examination during partial nephrectomy, in whom a re-resection of the margin or a completion nephrectomy was performed. Patients with renal cancer who underwent partial nephrectomy were considered. If the patient had a positive margin and underwent completion...

Since its introduction in 2004 by Gettman and colleagues,1 robot-assisted partial nephrectomy (RAPN) has been steadily gaining acceptance as part of a new standard of care for the treatment of localized renal malignancy. However, this rise to prominence has not been without its share of difficulties.

With the rise in detection of small renal masses that are amenable to nephron-sparing surgical approaches, there has been an increasing need for renal tumor models that create discrete lesions suitable for training exercises. We aim to investigate a handful of commonly used compounds, subjectively evaluating their ease of implementation and imaging...

Robot-assisted partial nephrectomy (RAPN) is emerging as a viable approach for nephron-sparing surgery (NSS), though many reports to date have been limited by evaluation of a relatively small number of patients. We present the largest multicenter RAPN experience to date, culling data from four high-volume centers, with focus upon functional and onc...

INTRODUCTION AND OBJECTIVES Studying acute changes in ureteral activity and renal hemodynamics following ureteral stone obstruction in a solitary kidney or bilateral system may be important in the management of patients with stone colic. We studied ureteral peristalsis, intrapelvic pressure(IPP) and renal resistive index (RI) in an in vivo porcine...

INTRODUCTION AND OBJECTIVES Shockwave lithotripsy (SWL) has undergone significant evolution since its introduction in the 1980's. The Dornier HM3, the first lithotripter widely available in the United States, has been phased out at most centers in favor of later-generation systems. However, there remains a paucity of information regarding the compa...