1096 ANATOMIC COMPLEXITY QUANTITATED BY NEPHROMETRY SCORE IS AN INDEPENDENT PREDICTOR OF URINARY LEAK FOLLOWING PARTIAL NEPHRECTOMY

Abstract

You have accessJournal of UrologyKidney Cancer: Localized I1 Apr 20121096 ANATOMIC COMPLEXITY QUANTITATED BY NEPHROMETRY SCORE IS AN INDEPENDENT PREDICTOR OF URINARY LEAK FOLLOWING PARTIAL NEPHRECTOMY Jay Simhan, Marc Smaldone, Kevin Tsai, Tianyu Li, Anthony Corcoran, Serge Ginzburg, Steven Sterious, Jose Reyes, Rosalia Viterbo, David Chen, Richard Greenberg, Alexander Kutikov, and Robert Uzzo Jay SimhanJay Simhan Philadelphia, PA More articles by this author , Marc SmaldoneMarc Smaldone Philadelphia, PA More articles by this author , Kevin TsaiKevin Tsai Philadelphia, PA More articles by this author , Tianyu LiTianyu Li Philadelphia, PA More articles by this author , Anthony CorcoranAnthony Corcoran Philadelphia, PA More articles by this author , Serge GinzburgSerge Ginzburg Philadelphia, PA More articles by this author , Steven SteriousSteven Sterious Philadelphia, PA More articles by this author , Jose ReyesJose Reyes Philadelphia, PA More articles by this author , Rosalia ViterboRosalia Viterbo Philadelphia, PA More articles by this author , David ChenDavid Chen Philadelphia, PA More articles by this author , Richard GreenbergRichard Greenberg Philadelphia, PA More articles by this author , Alexander KutikovAlexander Kutikov Philadelphia, PA More articles by this author , and Robert UzzoRobert Uzzo Philadelphia, PA More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.1204AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Urinary leak is among the most common urologic complications in patients undergoing partial nephrectomy (PN) for localized renal masses. Our objective was to assess the relationship between anatomic complexity quantitated by nephrometry score (NS) and urine leak following PN. METHODS We queried our prospectively maintained institutional kidney cancer database for all patients undergoing PN from 2007-2011. Tumors were categorized into low (NS 4-6), moderate (NS 7-9), and high (NS 10-12) anatomic complexity groups. Urine leak complications were graded from I-V using the Clavien-Dindo Classification System (CCS) and stratified as minor (CCS I-II) or major (CCS III-V) in severity. Patient and tumor characteristics were compared between major and minor urine leak groups using Wilcoxon and Chi-square tests. We further examined the effect of increasing anatomic complexity on the development of minor or major urine leaks using multiple logistic regression analyses controlling for patient and tumor characteristics. RESULTS 512 patients (median age 59yrs, range 21-83yrs, 64.3% male) undergoing PN (median NS 8.0, range 4-12, median tumor size 3.0cm, range 0.9-20cm) with median follow-up of 23 months (range 5-48). The incidence of minor and major urine leaks were 3.9% and 4.7% respectively. Comparing patients who developed a major, minor, or no urine leak, differences were observed between groups in tumor size (p<0.001), ischemia time (p<0.0001), and operative duration (p<0.01), while no differences were noted with respect to age, race, gender, BMI, ECOG performance status, and ASA score. When stratified by low, intermediate, and high NS complexity groups, rates of minor (0% vs. 4.2% vs. 10.4%, p=0.007) and major (0.7% vs. 3.5% vs. 16.9%, p<0.0001) urine leaks were significantly different. Controlling for age, gender, BMI, ECOG performance status, ASA score, operative time, and ischemia time, increasing Nephrometry Score was an independent predictor of sustaining either a minor (OR 2.0, CI 1.2-3.2) or major (OR 2.5, CI 1.4-4.6) urine leak following PN. CONCLUSIONS Increasing anatomic complexity quantitated by Nephrometry Score is an independent predictor of minor and major urine leak following PN. Our findings should be validated externally and integrated into preoperative patient counseling prior to treatment decisions in patients presenting with a complex renal mass. © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187Issue 4SApril 2012Page: e444-e445 Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.MetricsAuthor Information Jay Simhan Philadelphia, PA More articles by this author Marc Smaldone Philadelphia, PA More articles by this author Kevin Tsai Philadelphia, PA More articles by this author Tianyu Li Philadelphia, PA More articles by this author Anthony Corcoran Philadelphia, PA More articles by this author Serge Ginzburg Philadelphia, PA More articles by this author Steven Sterious Philadelphia, PA More articles by this author Jose Reyes Philadelphia, PA More articles by this author Rosalia Viterbo Philadelphia, PA More articles by this author David Chen Philadelphia, PA More articles by this author Richard Greenberg Philadelphia, PA More articles by this author Alexander Kutikov Philadelphia, PA More articles by this author Robert Uzzo Philadelphia, PA More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...