Bilateral Partial Nephrectomy Research Articles

Bilateral simultaneous partial nephrectomy

Introduction. Partial nephrectomy is the treatment of choice for small renal tumors. There are other indications include tumors in a solitary kidney, multiple and bilateral tumors.Сase presentation. A 67-year-old male presented with left flank pain and lower urinary tract symptoms. Computed tomography for abdominal and pelvis showed bilateral renal masses. After doing the essential laboratory tests and investigations, he underwent bilateral open simultaneous partial nephrectomies. After two days, he was discharged with no complains. Follow-up after three months showed no recurrence and acceptable renal function.Discussion. Partial nephrectomy is increasingly used for the management of renal masses. The preservation of renal function with reduced morbidity and equivalent oncologic outcomes led to a paradigm shift away from radical nephrectomy.Conclusion. Bilateral partial nephrectomy is feasible with both clinical and oncological good results.

Selective angioembolization in symptomatic renal angiomyolipoma: A series of four cases along with review of literature

Abstract The management of renal angiomyolipoma (R-AML) should be characterized on the basis of symptoms and/or the presence of associated risk factors of hemorrhage. In total, four cases of large symptomatic R-AML were visited in our urology out-patient department within the 9-month period. They underwent selective angioembolization (SAE) and were followed up for at least 3 months. Case 1—A 40-year-old female with bilateral R-AML, largest 4 cm × 8 cm × 9 cm lesion on right kidney. Postangioembolization, she underwent a right partial nephrectomy and is in further follow-up with contrast-enhanced computed tomography of the kidney ureter bladder (KUB) region (CECT KUB). Case 2—A 36-year-old female had bilateral large R-AML associated with active bleeding and perinephric hematoma on her right side and underwent urgent SAE. Follow-up CECT KUB revealed bilateral large AML with no evidence of perinephric hematoma. Now, we are planning for a bilateral partial nephrectomy. Case 3—A 52-year-old female with symptomatic 54 × 53 mm left mid-pole R-AML. She developed postembolization syndrome and managed it conservatively. Follow-up CECT KUB revealed a marked reduction of the left R-AML lesion (1 cm × 1 cm). Case 4—A 41-year-old female with 44 mm × 40 mm exophytic upper pole right R-AML with active bleed underwent urgent SAE. Follow-up CECT KUB revealed right kidney AML lesion size reduction (27 mm × 28 mm) with no perinephric hematoma. SAE is better suited for AML with acute hemorrhage or patients with multiple comorbidities or multiple AML lesions. For large AMLs, SAE can also be used before surgery to decrease the size of tumors and the possibilities of procedural difficulty for nephron-sparing surgery.

Novel original suture technique in partial nephrectomy: experimental evaluation of efficacy

Introduction. Nephron-sparing surgery for localised renal cell carcinoma has firmly entered the guideline base of all urological associations. One important aspect of this surgery is the management of the renal wound after partial nephrectomy. The abundance of haemostasis methods is not only the result of relentless search, but also the real lack of universal and effective technologies.Objective. To evaluate the effectiveness of various suture techniques in partial nephrectomy.Materials & methods. The suture techniques were studied on laboratory mature male rats weighing 280 – 350 g with bilateral partial nephrectomy. The groups were assessed: suture time and relative suture eruption rate as the ratio of the number of eruptions to the total number of ligatures tied, morphological appearance of the resection line on days 7 and 28.Results. In the continuous and novel suture groups, suture time and heat ischaemia time were comparable (p = 0.068). In the group of horizontal interrupted sutures, this indicator was significantly higher (p < 0.01). Optimization of the renorraphy technique using the novel original suture made it possible to reduce the incidence of eruption and hemorrhagic complications by 19.7% compared to the twist suture (p<0.05). The use of a novel experimental suture made it possible to speed up the suturing time by 38.5%, and to reduce the risks of morphologically confirmed acute renal injury by 58.0% compared with the classic suturing technique of renal parenchyma. This group showed mild inflammatory and necrotic changes along the suture line with resorption by the fourth week of follow-up.Conclusion. Thus, the novel surgical suture made it possible not only to overcome the problem of insufficient mechanical strength inherent in vertical sutures, to reduce the risk of thread eruption, tangential deformities, and ischemia, but also to provide an acceptable heat ischemia time. This contributed to minimal ischemic and inflammatory changes among the three study groups.

Case of the Month from the Peter MacCallum Cancer Centre, Melbourne, Australia: combination of stereotactic ablative body radiotherapy and radical nephrectomy for synchronous bilateral primary renal cell carcinoma.

Case of the Month from the Peter MacCallum Cancer Centre, Melbourne, Australia: combination of stereotactic ablative body radiotherapy and radical nephrectomy for synchronous bilateral primary renal cell carcinoma.

A novel missense mutation in the folliculin gene associated with the renal tumor-only phenotype of Birt-Hogg-Dubé syndrome

Birt-Hogg-Dubé syndrome is an autosomal dominant disease caused by germline mutations in the folliculin gene (FLCN), characterized by skin fibrofolliculomas, pulmonary cysts, and multiple renal tumors. We report the case of a 51-year-old woman with multiple bilateral renal tumors resected by bilateral open partial nephrectomy. Following pathological diagnosis of hybrid oncocytic/chromophobe tumors, targeted next-generation sequencing of FLCN of the patient's blood revealed a novel missense mutation (c.602A>C, p.Gln201Pro) in exon 6. Sanger sequencing revealed that this mutation was heterozygous. In silico prediction programs consistently indicated the mutation as pathogenic. Western blot analysis and immunohistochemistry revealed suppressed FLCN expression and the upregulation of glycoprotein nonmetastatic B, a downstream target negatively regulated by FLCN, in the tumor tissue, suggesting that the mutation resulted in reduction of functional FLCN expression. Whole-genome sequencing of one of the tumors identified another frameshift mutation in exon 4, suggesting a “second hit” leading to tumorigenesis. We recommend that gene sequencing should be considered in patients with multiple renal tumors to identify their genetic predisposition to renal tumors.

WAGR, Sex Reversal, Bilateral Gonadoblastomas, and Intralobar Nephrogenic Rests: Uncertainties of Pre-Biopsy Chemotherapy in a High Risk Syndrome for Nephroblastoma.

Background: WT1 deletions are associated with nephroblastomas, WT mutations are associated with 46, XY sex reversal. It is unclear why only a few WT1 deletions are associated with sex reversal. Case report. This 46, XY female had a 15.2 MB interstitial deletion of 11p14.1p11.2, which included WT1 and FSHB. No pathogenic abnormalities were identified in 156 other genes associated with disorders of sexual development. Bilateral gonadoblastomas were incidentally diagnosed at 17 months of age at the time of prophylactic gonadectomies. She was treated without biopsy for bilateral nephroblastomas radiologically identified at 18 months of age. Bilateral partial nephrectomies contained treated intralobular nephrogenic rests. Conclusion: It is unclear why WT1 deletions are less associated with 46, XY sex reversal than WT1 mutations. Treating suspected nephroblastomas without biopsy, even in patients with syndromes associated with bilateral nephroblastomas, may still lead to diagnostic and therapeutic uncertainties.

Bilateral Renal Oncocytoma: Active Surveillance Versus Partial Nephrectomy

Renal oncocytomas (ROs) are benign tumors comprising 16% of renal masses. Due to the overlapping phenotypes seen in RO and chromophobe renal cell carcinoma (RCC) and lack of specific clinical and laboratory characteristics of RO, physicians face a challenge when arriving at a definitive diagnosis of RO. ROs additionally appear indistinct from RCCs on CT scan, contributing further to the difficulty of arriving at a clear diagnosis of RO. This is a case report of a 66-year-old man who presented with flank pain found to be related to bilateral ROs and underwent bilateral partial nephrectomies.ROs are benign small renal masses that often pose a diagnostic challenge since preoperative diagnosis can be difficult to achieve. Given advancements in technology, active surveillance with core renal biopsy is a promising approach to accurately diagnose and manage ROs conservatively. The application of these techniques has wide-reaching implications for patients and physicians by reducing the need for a potentially harmful surgery and creating a cost-effective way to manage a diagnosis.

When Your Pituitary Fails - A Rare Case of Pituitary Dysfunction Due to Nivolumab and Ipilimumab

Introduction: Immunomodulators like Nivolumab and Ipilimumab are important regimens in many malignancies. However, their use is linked with the rare side effect of pituitary dysfunction that if screened and treated can prevent misdiagnosis. Case Description: A 56-year-old male with a history of renal cell carcinoma status post bilateral partial nephrectomy with metastasis to the lung on Nivolumab/Ipilimumab presented with dizziness. He endorsed difficulty with balance, nausea, decreased appetite, feeling dehydrated and recent blood pressure readings in the 90s. Vitals on presentation were stable. An MRI, from 2 weeks ago, showed a slightly enlarged sella but no metastatic disease. The next day, he became hypotensive with minimal response to fluids and was started on Midodrine. However, considering his persistent hypotension, his cortisol level was checked and found to be profoundly low (<1). Literature review of his immunomodulator revealed the possibility of central adrenal insufficiency. In addition, he was noted to have a low TSH (0.02) with normal FT4 (1.08). Subsequently, his ACTH level was also found to be low (<1.5) which further elucidated a central cause for his adrenal insufficiency. Therefore, he was ultimately treated with PO hydrocortisone with plans to taper off in the next few weeks. Conclusion: This case demonstrates a rare yet significant side effect of Nivolumab/Ipilimumab therapy. Timely diagnosis and therapy can alleviate symptoms due to associated hormonal deficiencies. Moving forward it will be interesting to see if starting prophylactic steroids or routine screening will allow us to diagnose pituitary dysfunction due to Nivolumab/Ipilimumab earlier.

Bilateral kidney metastases from adenoid cystic carcinoma of lung: a case report and literature review

Adenoid cystic carcinoma (ACC) is a rare malignant tumor, usually arising from salivary glands and rarely found in other locations. ACC is characterized by asymptomatic course, slow growth pattern, perineural invasion and high incidence of late metastasis. Renal localization of metastasis is rare. Only 12 cases of renal metastasis were published and, to our best knowledge, no case of bilateral metastasis to the kidney has ever been reported. We present a case of a 58years old woman with bilateral renal metastasis from ACC of the right lung after fourteen years from lobectomy and radiotherapy for the primary presentation. The patient underwent bilateral robot-assisted partial nephrectomy in a two-stage approach. Despite its rare incidence and slow growth, ACC metastasis may simulate primary papillary renal carcinoma and occur many years after primary treatment. Therefore, lifelong follow-up, including abdominal imaging, is recommended.

Kidney Outcomes and Hypertension in Survivors of Wilms Tumor: A Prospective Cohort Study

To assess the prevalence of therapy-related kidney outcomes in survivors of Wilms tumor (WT). This prospective cohort study included survivors of WT who were ≥5years old and ≥1year from completing therapy, excluding those with preexisting hypertension, prior dialysis, or kidney transplant. Participants completed 24-hour ambulatory blood pressure monitoring (ABPM). Abnormal blood pressure (BP) was defined as ≥90th percentile. Masked hypertension was defined as having normal office BP and abnormal ABPM findings. Urine was analyzed for kidney injury molecule-1, interleukin-18, epidermal growth factor, albumin, and creatinine. The estimated glomerular filtration rate (eGFR) was calculated using the bedside chronic kidney disease in children equation. Recent kidney ultrasound examinations and echocardiograms were reviewed for contralateral kidney size and left ventricular hypertrophy, respectively. Clinical follow-up data were collected for approximately 2years after study enrollment. Thirty-two participants (median age, 13.6years [IQR, 10.5-16.3years]; 75% stage 3 or higher WT) were evaluated at a median of 8.7years (IQR, 6.5-10.8years) after therapy; 29 participants underwent unilateral radical nephrectomy, 2 bilateral partial nephrectomy, and 1 radical and contralateral partial nephrectomy. In this cohort, 72% received kidney radiotherapy and 75% received doxorubicin. Recent median eGFR was 95.6mL/min/1.73m2 (IQR, 84.6-114.0; 11 [34%] had an eGFR of <90mL/min/1.73m2). Abnormal ABPM results were found in 22 of 29 participants (76%), masked hypertension in 10 of 29 (34%), and microalbuminuria in 2 of 32 (6%). Of the 32 participants, 22 (69%) had abnormal epidermal growth factor; few had abnormal kidney injury molecule-1 or interleukin-18. Seven participants with previous unilateral nephrectomy lacked compensatory contralateral kidney hypertrophy. None had left ventricular hypertrophy. In survivors of WT, adverse kidney outcomes were common and should be closely monitored.

Simultaneous versus staged partial nephrectomies for bilateral synchronous solid renal masses

ObjectivesThe optimal management approach for synchronous bilateral renal masses is unknown, particularly regarding surgical sequencing of bilateral partial nephrectomy (PN). We evaluated the impact of simultaneous vs. staged bilateral PN on renal functional, perioperative, and oncologic outcomes. Patients and MethodsWe reviewed our institutional nephrectomy registry to identify patients who underwent simultaneous or staged (within 6 months) bilateral PN for nonmetastatic bilateral synchronous solid renal masses between 1980 and 2015. Short-term and long-term renal function changes were assessed at 3 and 12 months, respectively. Perioperative outcomes were pooled across staged surgeries by taking the sum of each outcome. Local recurrence-free, distant metastases-free, cancer-specific, and overall survival were estimated using the Kaplan-Meier method. Outcomes were compared by surgical sequencing approach. A sensitivity analysis was performed that grouped approaches by preoperative intent. ResultsAmong the 107 patients studied, 77 (72%) underwent simultaneous and 30 (28%) underwent staged PN. The majority of PN were performed by open approach. Clinicopathologic features were similar between groups. Patients who underwent simultaneous PN had lower mean short-term (−6% vs. −24%, P = 0.015) and median long-term (−4% vs. −22%, P < 0.001) reduction in eGFR vs. staged PN, respectively. Furthermore, patients with simultaneous PN had lower pooled length of stay (median 6 vs. 8 days, P < 0.001), rate of urine leak (3% vs. 17%, P = 0.018), and rate of high-grade complications (8% vs. 23%, P = 0.044), relative to staged PN, respectively. However, on sensitivity analysis, only differences in long term reduction in estimated glomerular filtration rate and length of stay remained. There were no significant differences in oncologic outcomes between groups. ConclusionsOur results suggest that when technically feasible, simultaneous PN yields comparable outcomes vs. staged PN, offering a reasonable surgical sequencing approach for patients presenting with bilateral synchronous renal masses.

R.E.N.A.L. nephrometry scoreの高い両側腎細胞癌に対して，術前3次元模型シミュレーションと経皮経膀胱的尿管ステント留置を行い，両側腎部分切除を完遂した1例

R.E.N.A.L. nephrometry scoreの高い両側腎細胞癌に対して，術前3次元模型シミュレーションと経皮経膀胱的尿管ステント留置を行い，両側腎部分切除を完遂した1例

MP31-07 SIMULTANEOUS VERSUS STAGED PARTIAL NEPHRECTOMIES FOR BILATERAL SYNCHRONOUS SOLID RENAL MASSES

INTRODUCTION AND OBJECTIVES:The optimal surgical management for bilateral synchronous solid renal masses is controversial, particularly regarding the performance of bilateral partial nephrectomy (P...

Bilateral benign renal oncocytomas and the role of renal biopsy: single institution review

BackgroundThe goal was to assess the natural history and management of patients with pathologically proven bilateral (synchronous) RO after undergoing initial partial nephrectomy (PN).MethodsAll patients underwent either robotic/laparoscopic or open PN by two experienced genitourinary oncologists from 2005–2013. Final pathology was determined by surgical excision, CT-guided percutaneous core biopsy (CT-biopsy) or fine needle aspiration (FNA). Patient demographics, tumor characteristics (pathologic data, location, size) type of surgery, pre/post estimated glomerular filtration rate (eGFR) and surgical complications were recorded.ResultsTwelve patients were identified with bilateral RO. Median age at the time of surgery was 68 years (46–77) (Table 1). The median size of the largest tumor(s) resected was 2.75 cm (1.5–5.5 cm) and second largest tumor(s) was 1.75 cm (1.0–4.0 cm). Four patients underwent bilateral staged PN and one patient underwent simultaneous bilateral PN (horseshoe kidney). Two patients underwent RFA at the time of biopsy of the contralateral mass after PN. Five patients underwent CT-bx/FNA (5/5) of the contralateral mass followed by active surveillance.Mean follow up was 34 months. There was no significant change in median creatinine pre- and post-operatively. One patient was lost to follow up and one patient died of unknown causes 5 years post-operatively. eGFR decreased an average of 16.96% post-operatively, including a single patient whose eGFR increased by 7.8% after surgery and a single patient whose eGFR did not change (Table 2).ConclusionsPatients with bilateral renal masses and pathologically proven RO can be safely managed with active surveillance after biopsy confirmation of the contralateral mass.

Management of Bilateral Wilms' Tumor: Our Experience.

Management of bilateral Wilms' tumor is particularly challenging, considering the chances of recurrence and long-term renal function for affected patients. Aggressive surgical resection to prevent recurrence must be balanced with the desire to preserve renal function. We evaluated our experience in the management of bilateral Wilms' tumor stressing the challenges encountered in decision making and the role of nephron sparing surgery. We had four children presenting with bilateral Wilms' tumor. All of them were appropriately staged and given standard chemotherapy as per NWTS-5 guidelines. Tumors were considered to have a 'good' response to chemotherapy if sufficient tumor shrinkage was observed so that renal hilum was seen free of tumor and vice versa. Nephron-sparing surgery was considered in all and was performed when feasible, followed by completion adjuvant chemotherapy. All patients were followed up with serial ultrasound scans (3-6 monthly) and CECT abdomen (yearly once). Blood urea and serum creatinine, hypertension, and proteinuria were assessed during follow-up visits. All four children received neo-adjuvant chemotherapy as per NWTS-5 guidelines. The first child had poor response to chemotherapy and was considered for left radical and right partial nephrectomy. However, patient attenders refused any surgical intervention and the child was taken home. The second child had a 'good' response on left side and was planned for left partial and right radical nephroureterectomy based on pre-operative imaging analysis. However, intra-operatively, bilateral partial nephrectomy with good margins was feasible. The third child though, showed 'poor' response to pre-op chemotherapy and warranted bilateral nephroureterectomy, right partial and left radical nephroureterectomy was feasible. However, in the fourth child, we were not able to perform nephron sparing surgery and left nephroureterectomy with right tumor biopsy was done. Following this, child was started on 2nd-line chemotherapy, now awaiting right partial nephrectomy. The second child is on follow up for 1.5years, doing well. However, the third child expired 1.5years following surgery due to recurrence (lung metastasis). Management of bilateral Wilm's tumor is challenging and nephron-sparing surgery should be considered in all patients having bilateral Wilm's tumor with favorable histology, even if pre-operative imaging studies suggest that the lesions are unresectable.

VE19 - Pre-operative planning based on 3D kidney modeling for bilateral complex robotic partial nephrectomy under super selective clamping

VE19 - Pre-operative planning based on 3D kidney modeling for bilateral complex robotic partial nephrectomy under super selective clamping

Robotic Laparoendoscopic Single-site Retroperitioneal Renal Surgery: Initial Investigation of a Purpose-built Single-port Surgical System

BackgroundRobotic single-site retroperitoneal renal surgery has the potential to minimize the morbidity of standard transperitoneal and multiport approaches. Traditionally, technological limitations of non–purpose-built robotic platforms have hindered the application of this approach. ObjectiveTo assess the feasibility of retroperitoneal renal surgery using a new purpose-built robotic single-port surgical system. Design, setting, and participantsThis was a preclinical study using three male cadavers to assess the feasibility of the da Vinci SP1098 surgical system for robotic laparoendoscopic single-site (R-LESS) retroperitoneal renal surgery. Surgical procedureWe used the SP1098 to perform retroperitoneal R-LESS radical nephrectomy (n=1) and bilateral partial nephrectomy (n=4) on the anterior and posterior surfaces of the kidney. Improvements unique to this system include enhanced optics and intelligent instrument arm control. Access was obtained 2cm anterior and inferior to the tip of the 12th rib using a novel 2.5-cm robotic single-port system that accommodates three double-jointed articulating robotic instruments, an articulating camera, and an assistant port. MeasurementsThe primary outcome was the technical feasibility of the procedures, as measured by the need for conversion to standard techniques, intraoperative complications, and operative times. Results and limitationsAll cases were completed without the need for conversion. There were no intraoperative complications. The operative time was 100min for radical nephrectomy, and the mean operative time was 91.8±18.5min for partial nephrectomy. Limitations include the preclinical model, the small sample size, and the lack of a control group. ConclusionsSingle-site retroperitoneal renal surgery is feasible using the latest-generation SP1098 robotic platform. While the potential of the SP1098 appears promising, further study is needed for clinical evaluation of this investigational technology. Patient summaryIn an experimental model, we used a new robotic system to successfully perform major surgery on the kidney through a single small incision without entering the abdomen.

Bilateral renal cancers: oncological and functional outcomes.

The authors assessed the characteristics of bilateral renal cancers. From January 1995 to January 2015, 65 patients underwent surgery for bilateral renal cancers. Thirty-four of the patients had 36 synchronous tumors, while the remaining 29 had metachronous tumors. The mean age of the patients was 60±11years. There were 22 females and 43 males. In all cases, bilateral partial nephrectomies or unilateral nephrectomy and contralateral nephron-sparing surgery were performed. The mean sizes of the synchronous tumors were 5.0±2.7 and 4.7±3.0cm at the first and the second operations, respectively. The average diameters of the metachronous carcinomas were 6.6±3.0 and 3.1±1.6cm at the initial and the second surgeries, respectively. Histologic concordance was 91.1% in the synchronous and 96.5% in the metachronous tumors. The mean postoperative creatinine levels increased by 116%, while the GFR decreased by 44.8% in synchronous tumors at the second operation. The mean postoperative creatinine levels increased by 42%, while the GFR decreased by 30.4% in metachronous carcinomas at the second operation. The mean follow-up time was 4.8±3.7years. During this period, distant metastases occurred in two patients with synchronous tumors and in six cases with metachronous tumors. Local recurrences were detected in one case of synchronous tumor and in four patients with metachronous carcinomas. The 5-year overall and tumor-specific survivals were 53 and 80%, respectively. In patients with bilateral renal carcinomas, the histologic concordance was 93.6%. The bilateral partial nephrectomies or unilateral nephrectomy and contralateral resection provided acceptable oncological and functional outcomes.

Bilateral Synchronous Sporadic Renal Cell Carcinoma: Retroperitoneoscopic Strategies and Intermediate Outcomes of 60 Patients.

ObjectiveTo evaluate the presentation, management, pathology, and functional and oncological outcomes of patients undergoing retroperitoneoscopic treatment of bilateral synchronous sporadic RCC at our institution.MethodsWe retrospectively evaluated the records of 60 patients with bilateral synchronous sporadic RCC who underwent retroperitoneoscopic treatment at the General Hospital of People's Liberation Army from 2008 to 2014. The estimated glomerular filtration rate was calculated and compared among different surgical procedures. The overall survival and recurrence free survival were assessed based on information from recent follow-up.ResultsFifty-six patients underwent bilateral retroperitoneoscopic surgeries in staged procedures, and four patients underwent bilateral retroperitoneoscopic surgeries in simultaneous procedures. Among the former group of patients, 34 underwent bilateral partial nephrectomy, 12 underwent radical nephrectomy followed by partial nephrectomy, and 10 underwent partial nephrectomy followed by radical nephrectomy. Bilateral partial nephrectomy can better preserve renal function (p = 0.040) and the sequence of partial nephrectomy and radical nephrectomy did not affect functional outcomes (p = 0.790). One patient undergoing simultaneous procedures developed acute renal failure and required temporary hemodialysis. At 3 and 5 years, overall survival rates were 93.0% and 89.4%, and recurrence free survival rates were 90.5% and 81.6%. High nuclear grade (p = 0.014) was related to disease recurrence.ConclusionsStaged bilateral partial nephrectomy was efficient in preserving renal function. The survival of patients with bilateral synchronous sporadic renal tumors was similar to that of patients with unilateral nonmetastatic tumors. Nuclear grade was an independent prognostic factor of disease recurrence.

Bilateral Laparoscopic Partial Nephrectomies: A Case Report

Although laparoscopy is a recognized operative approach to the management of renal masses, there is currently no standardized approach to manage bilateral synchronous renal masses. We present a case of synchronous bilateral renal masses, identified during work-up for flank pain, and managed simultaneously with laparoscopic partial nephrectomies. The patient is a 42-year-old Caucasian male found to have bilateral renal masses during evaluation for left flank pain. Cross-sectional imaging studies showed a 7.0 × 7.3 × 5.2 cm anterior, mid-to-lower pole mass on the left kidney and a 1.5 × 1.9 × 1.6 cm medial lower pole mass on the right kidney. He underwent bilateral laparoscopic partial nephrectomy at the same setting, with an uncomplicated postoperative course. Pathology report revealed clear cell renal-cell carcinoma (ccRCC) on both sides. He had normal renal function and no evidence of recurrence in the first 6 months of follow-up. This case demonstrates the possibility and safety of performing bilateral laparoscopic partial nephrectomies in one operative session. Our review of the literature supports the role of genetic counseling and the need for long-term surveillance in young patients having RCC.