1790 RENAL PELVIC ANATOMY IS ASSOCIATED WITH URINE LEAK FOLLOWING OPEN PARTIAL NEPHRECTOMY

Abstract

You have accessJournal of UrologyKidney Cancer: Localized (V)1 Apr 20131790 RENAL PELVIC ANATOMY IS ASSOCIATED WITH URINE LEAK FOLLOWING OPEN PARTIAL NEPHRECTOMY Jeffrey Tomaszewski, Marc Smaldone, Bic Cung, Reza Mehrazin, Anthony Corcoran, Serge Ginzburg, Rosalia Viterbo, David Chen, Richard Greenberg, Alexander Kutikov, and Robert Uzzo Jeffrey TomaszewskiJeffrey Tomaszewski Philadelphia, PA More articles by this author , Marc SmaldoneMarc Smaldone Philadelphia, PA More articles by this author , Bic CungBic Cung Philadelphia, PA More articles by this author , Reza MehrazinReza Mehrazin 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 , 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.2013.02.2840AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The most frequent surgical complication associated with partial nephrectomy is urinary leak. We evaluated renal pelvic anatomy as an independent predictor of leak in moderate and high complexity tumors undergoing NSS. METHODS Using our prospective RCC database, we identified all patients undergoing open partial nephrectomy (PN) for localized RCC (2007−2012). Patients were stratified into intermediate (7−9) and high (10−12) complexity groups using nephrometry score (NS). A Renal Pelvic Score (RPS) was defined by the percentage of renal pelvis contained inside the volume of the renal parenchyma; patients were classified as having an intra or extraparenchymal renal pelvis (Figure 1). ANOVA and chi square tests were used to compare characteristics between patients with and without an intraparenchymal renal pelvis. RESULTS 255 patients (mean age 58±12 years; mean Charlson comorbidity count (CCI) 1.4±1.7; 62.8% male) undergoing PN for intermediate (73.6%) and complex (26.4%) localized renal tumors (mean size 4.6±2.9cm, mean NS 8.7±1.1cm) met inclusion criteria. 24 (9.6%) of renal pelvis's were classified as completely intraparenchymal. Comparing patients by renal pelvis classification group, significant differences were seen with respect to co-morbidity (CCI), BMI, and largest tumor size (all p values ≤ 0.05). On univariate analysis following stratification by RPS, groups differed with respect to co-morbidity (CCI), BMI, and largest tumor size (all p values ≤ 0.05). No differences were observed between hospital length of stay, NS, estimated blood loss, operative time, and age. Intrarenal pelvic anatomy was associated with a markedly increased risk of urine leak (75% vs. 6.5%, p=0.001), secondary intervention (37.5% vs. 3.9%, p<0.001), and prolonged duration of urine leak (p=0.025). CONCLUSIONS In our large institutional cohort, renal pelvic anatomy assessed by RPS is associated with an increased rate of urine leak following open partial nephrectomy for intermediate and high complexity tumors. Elevated pressures within a small intraparenchymal renal pelvis could explain the increased risk. Pre-operative imaging characteristics suggestive of increased risk for urine leak should be considered in peri-operative management algorithms. © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189Issue 4SApril 2013Page: e735-e736 Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.MetricsAuthor Information Jeffrey Tomaszewski Philadelphia, PA More articles by this author Marc Smaldone Philadelphia, PA More articles by this author Bic Cung Philadelphia, PA More articles by this author Reza Mehrazin 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 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 ...