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Abstract

The previously mentioned perspective represents a great summary of the status of this field, with quality, quantity, and ischemia time representing the main determinants of ultimate renal function after partial nephrectomy. In reality, we have made a great progress over the past few years. As recently as 2010 there was a near total focus on ischemia, and we now have a much greater appreciation of its relative contributions. We have learned that most preserved nephrons will recover from the ischemic insult, provided that it is maintained within reasonable limits or associated with hypothermia. The commentary also alludes to one of the ongoing controversies that will mandate further investigation, namely whether patients with pre-existing chronic kidney disease are more vulnerable to ischemic injury. Our experience with more than 600 patients with a solitary kidney managed with partial nephrectomy, most of whom have had pre-existing chronic kidney disease, suggests otherwise. However, to our knowledge, a comprehensive analysis of this specific issue has not been reported yet. Editorial CommentUrologyVol. 82Issue 2PreviewThis study evaluates the role of volume preservation and ischemia during open and minimally invasive partial nephrectomy as evaluated by functional (Mag3) and computed tomography volumetric analysis using free-hand scripting. The authors find that the ultimate renal function after partial nephrectomy was primarily driven by parenchymal preservation with ischemia playing a secondary role as long as it was within a limited period. The article elaborates and further supports the concept of renal parenchymal preservation as the primary predictor of unilateral renal function after partial nephrectomy. Full-Text PDF