Concurrent Nephrectomy Research Articles

Retroperitoneal ganglioneuroma: A five-case series from a single Tunisian center

Introduction and importanceRetroperitoneal ganglioneuroma is an infrequent, benign tumor originating from the sympathetic nervous system. The diagnosis predominantly relies on histological assessment, often as an incidental discovery. Surgical removal stands as the primary treatment modality, and the overall prognosis tends to be favorable. Case presentationObjective: In order to comprehensively examine the diagnostic, therapeutic, and progressive aspects of retroperitoneal ganglioneuroma, this study aims to analyze five cases of retroperitoneal ganglioneuroma that were surgically managed between 1993 and 2013.Patients and methods: We present a series of five cases involving retroperitoneal ganglioneuromas that underwent surgical intervention in the urology department of Charles Nicolle Teaching Hospital of Tunis between the years 1993 and 2013. The study cohort comprised three females and two males, with an average age of 36.4 years (ranging from 10 to 88 years). Among these cases, four instances showcased incidental tumor detection, while one case manifested with cruralgia due to nerve compression. Complete tumor excision was achieved in all cases, with a single instance necessitating concurrent nephrectomy. Accurate diagnosis was ascertained through meticulous histological examination. Clinical discussionResults: The case series encompassed three women and two men, with an average age of 36.4 years (ranging from 10 to 88 years). The majority of cases (four out of five) unveiled tumors incidentally, whereas one case presented with cruralgia. Surgical removal resulted in complete resection of all tumors, although nephrectomy was necessary in one instance. Postoperative complications were minimal, and effective anticoagulant treatment addressed one thrombotic event. While recurrence was noted in a solitary case, subsequent imaging confirmed its stability. The average follow-up duration extended to 23.2 months (ranging from 6 to 72 months). ConclusionRetroperitoneal ganglioneuroma, being a rare and benign neoplasm, mandates meticulous pathological assessment and precise imaging for precise localization. Unquestionably, complete surgical resection remains paramount to forestall recurrence and mitigate the likelihood of malignant transformation. Overall, the prognosis associated with retroperitoneal ganglioneuroma tends to be favorable.

Radical cystectomy and urinary diversion outcomes in patients with single vs. double renal unit: A 2:1 matched-pair analysis.

To evaluate perioperative and functional outcomes of radical cystectomy (RC) and urinary diversion (UD) in patients with a single kidney (SK) vs. double kidneys (DK). We reviewed records of patients who underwent RC for bladder cancer with a history of prior or concurrent nephrectomy at USC between 2004 and 2020. Patients with chronic kidney disease who were already on dialysis were excluded. UD, perioperative complications, and postoperative glomerular filtration rate (GFR) of the SK group were compared with a group of patients who underwent RC with DK using 2:1 matching with respect to age, sex, preop GFR, and tumor stage. We included 186 patients (SK = 62 and DK = 124). Half of the SK patients underwent continent UD. SK patients had a higher length of hospital stay compared to the DK group; however, 90-day complications, readmission, and mortality rates were similar. In patients with continent diversion, SK vs. DK showed similar 90-day complications (71% vs. 69%, P = 1.0). SK patients had significantly lower GFRs at discharge, 3-, and 12-month following RC compared to the DK group. Postoperative GFRs of the SK patients with continent vs. incontinent UD were statistically similar. On multivariable analysis, UD (i.e. continent vs. incontinent) was not associated with post-op GFR decline at discharge, 3- and 12-month following RC. Perioperative outcomes of radical cystectomy patients with single kidney are similar to double kidney patients, except for more GFR decline in single kidney cases. Continent urinary diversion in single kidney is as safe as double kidney patients.

MP25-02 RADICAL CYSTECTOMY AND URINARY DIVERSION OUTCOMES IN PATIENTS WITH SINGLE VS. DOUBLE KIDNEY: A 2:1 MATCHED-PAIR ANALYSIS

You have accessJournal of UrologyCME1 May 2022MP25-02 RADICAL CYSTECTOMY AND URINARY DIVERSION OUTCOMES IN PATIENTS WITH SINGLE VS. DOUBLE KIDNEY: A 2:1 MATCHED-PAIR ANALYSIS Alireza Ghoreifi, Richard Mora, Sanam Ladi-Seyedian, Farshad Sheybaee Moghaddam, Jie Cai, Gus Miranda, Monish Aron, Anne Schuckman, Mihir Desai, Inderbir Gill, Siamak Daneshmand, and Hooman Djaladat Alireza GhoreifiAlireza Ghoreifi More articles by this author , Richard MoraRichard Mora More articles by this author , Sanam Ladi-SeyedianSanam Ladi-Seyedian More articles by this author , Farshad Sheybaee MoghaddamFarshad Sheybaee Moghaddam More articles by this author , Jie CaiJie Cai More articles by this author , Gus MirandaGus Miranda More articles by this author , Monish AronMonish Aron More articles by this author , Anne SchuckmanAnne Schuckman More articles by this author , Mihir DesaiMihir Desai More articles by this author , Inderbir GillInderbir Gill More articles by this author , Siamak DaneshmandSiamak Daneshmand More articles by this author , and Hooman DjaladatHooman Djaladat More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002568.02AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Limited data is available regarding the outcomes of patients with single kidney (SK) who undergo radical cystectomy (RC) and urinary diversion (UD). The aim of this study is to evaluate perioperative and functional outcomes of SK patients with bladder cancer (BC) who undergo RC. METHODS: We reviewed the records of patients who underwent RC for BC with history of prior or concurrent nephrectomy due to non-functional kidney, renal cancer, or upper tract urothelial carcinoma (UTUC) between 2004 and 2020. Patients with chronic kidney disease who were already on dialysis were excluded. UD, perioperative complications, and postoperative glomerular filtration rate (GFR) of the SK group were compared with a group of patients who underwent RC with double kidneys (DK) using 2:1 matching with respect to age, sex, preop GFR, and tumor stage. RESULTS: A total of 186 patients (SK=62 and DK=124) were included. Baseline features of these two groups were similar (Table 1-A). Half of the SK patients underwent continent UD. SK patients had a higher length of hospital stay compared to the DK group; however, 90-day complications, readmission, and mortality rates were similar (Table 1-B). In patients with continent diversion, SK vs. DK showed similar 90-day complications, including metabolic acidosis and dehydration (71% vs. 69%, p=1.0). In terms of GFR changes, SK group showed significantly lower GFRs at discharge as well as 3- and 12-months following RC compared to the DK group (Figure 1-A). Nevertheless, no significant difference was observed in postoperative GFRs of the SK patients with continent vs. incontinent UD (Figure 2-B). On multivariable analysis, UD (i.e., continent vs. incontinent) was not associated with post-op GFR decline at discharge, 3- and 12-months following RC. CONCLUSIONS: Perioperative outcomes of single kidney patients undergoing radical cystectomy are similar to double kidney patients, except for more GFR decline in single kidney cases. Continent urinary diversion in single kidney patients is as safe as double kidney cases. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e427 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Alireza Ghoreifi More articles by this author Richard Mora More articles by this author Sanam Ladi-Seyedian More articles by this author Farshad Sheybaee Moghaddam More articles by this author Jie Cai More articles by this author Gus Miranda More articles by this author Monish Aron More articles by this author Anne Schuckman More articles by this author Mihir Desai More articles by this author Inderbir Gill More articles by this author Siamak Daneshmand More articles by this author Hooman Djaladat More articles by this author Expand All Advertisement PDF DownloadLoading ...

PD19-05 DOES PERCENTAGE OF SEMINOMA AT ORCHIECTOMY IMPACT PATIENT MORBIDITY AND PATHOLOGIC OUTCOMES AT POST-CHEMOTHERAPY RETROPERITONEAL LYMPH NODE DISSECTION FOR MIXED GERM CELL TUMOR?

INTRODUCTION AND OBJECTIVE: Post-chemotherapy retroperitoneal lymph node dissections (PC-RPLND) for pure seminoma are widely considered to have an increased potential for surgical complexity and morbidity secondary to increased post-chemotherapy desmoplastic changes. This places patients at increased risk, often with pathologic findings only revealing necrosis. We sought to determine if the percentage of seminoma in the orchiectomy specimen predicts necrosis on PC-RPLND for non-seminomatous germ cell tumors (NSGCT) and the associated impact on patient morbidity. METHODS: Patients with seminoma in the orchiectomy specimen who underwent PC-RPLND for NSGCT at Indiana University from 2009-2019 were identified to assess pathologic findings, required ancillary procedures at the time of PC-RPLND, and post-operative outcomes. Patients were categorized into quartiles to assess if increasing percentage of seminoma predicted necrosis. RESULTS: Of the 109 patients identified, pathologic analysis revealed necrosis in 30/109 (27.5%), malignancy 17/109 (15.6%), and teratoma 62/109 (56.9%). As percent seminoma increased by quartile, necrosis was more prevalent (23.7%, 25%, 33.3%, 41.7%), as was the radiographic size decrease in post-chemotherapy retroperitoneal masses. For patients with greater than 90% seminoma, necrosis was found 50% of the time. The incidence of concurrent nephrectomy, need for intra-operative vascular repair, and estimated blood loss during PC-RPLND was greatest in the 4th quartile. There was no significant difference in pre-operative serum tumor markers, patient age, body mass index, pre-operative comorbidities, length of stay, or post-operative Clavien-Dindo classification outcomes. CONCLUSIONS: As percent seminoma in the orchiectomy specimen increased, the incidence of necrosis, surgical complexity, and the need for concurrent ancillary procedures increased. However, it did not seem to change the hospital course or post-operative morbidity. Unfortunately, these results show that PC-RPLND cannot be eliminated even in patients with very high orchiectomy seminoma percentages as over half of these patients had teratoma or viable malignant elements in the retroperitoneum. Source of Funding: None

Panniculectomy Outcomes in Patients with End-Stage Renal Disease in Preparation for Renal Transplant.

End-stage renal disease (ESRD) is associated with increased cardiovascular risk factors, electrolyte imbalances, and iron deficiency anemia. These factors may increase the risk of adverse outcomes in patients undergoing panniculectomy. There is a paucity of data regarding outcomes in patients with ESRD undergoing panniculectomy. The purpose of this study is to investigate whether ESRD is associated with increased rate of complications following a panniculectomy. The Nationwide Inpatient Sample database (2006-2011) was used to identify patients who underwent a panniculectomy. Among this cohort, patients diagnosed with end-stage renal disease were identified. Patients excluded from the study were emergency admissions, pregnant women, patients less than 18years old, and patients with concurrent nephrectomy or kidney transplants. Demographic factors, comorbidities, and postoperative complications were evaluated. Chi-squared and risk-adjusted multivariate logistic regression analyses were performed to determine whether end-stage renal disease was associated with increased rate of postoperative complications. A total of 34,779 panniculectomies were performed during the study period. Of these, 613 (1.8%) were diagnosed with ESRD. Patients with ESRD were older (mean age 58.9 vs. 49.3, p<0.01) and more likely to have Medicare (63.5 vs. 18.4%, p<0.01). They had higher rates of comorbidities, including diabetes, hypertension, congestive heart failure, chronic lung disease, chronic anemia, liver disease, peripheral artery disease, obesity, and coagulopathies (p<0.01). The procedure was more likely to occur at a large, teaching hospital (p<0.01). Postoperatively, patients with ESRD had a higher rate of death (3.3 vs. 0.2%, p<0.01), wound complications (10.6 vs. 6.2%, p<0.01), venous thromboembolism (4.9 vs. 0.8%, p<0.01), blood transfusions (25.3% vs. 7.0%, p<0.01), non-renal major medical complications (40.0% vs. 8.4%), and longer hospital stay (9.2 vs. 3.8days, p<0.01). Multivariate logistic regression analysis controlling for age, race, sex, hospital location/teaching hospital, payer, and all comorbidities demonstrated that ESRD was independently associated with increased venous thromboembolisms (OR 2.38, 95% CI 1.48-3.83) and non-renal major medical complications (OR 1.51, 95% CI 1.19-1.91). ESRD was not independently associated with increased rate of wound complications or transfusions. Patients with ESRD are at increased risk of VTE and non-renal major medical complications following panniculectomy. Moreover, patients with ESRD have longer hospital stays and higher rates of mortality. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Abstract: Panniculectomy Outcomes in Patients with End Stage Renal Disease

INTRODUCTION: Patients with end-stage renal disease (ESRD) may require a panniculectomy in preparation for renal transplantation. ESRD is associated with increased cardiovascular risk factors, electrolyte imbalances, and chronic anemia. These factors may increase the risk of adverse outcomes in patients undergoing panniculectomy. Purpose of this study was to evaluate safety and perioperative complication rates in ESRD patients following panniculectomy. METHODS: Nationwide Inpatient Sample (2006–2011) was employed to identify patients who underwent panniculectomy. Among this cohort, patients with ESRD were identified. Pregnant women, children, emergency admissions, and patients that underwent concurrent nephrectomy or renal transplants were excluded. Demographic factors, comorbidities, and postoperative complications were evaluated. Bivariate and risk-adjusted multivariate logistic regressions were performed to determine if ESRD was associated with increased rates of postoperative complications. RESULTS: A total of 34,779 panniculectomies were performed during the study period. Of these, 613 (1.8%) were performed in patients with ESRD. ESRD cohort was older (mean age 58.9 vs. 49.3, p<0.01) and with a higher proportion of men (29.9% vs 11.1%, p<0.01) than non-ESRD group. As expected, ESRD cohort had higher rates of co-morbidities (p<0.01). Most ESRD patients were treated at urban teaching hospitals (70.0% vs 59.8% for non-ESRD, p<0.01). Post-operatively, patients with ESRD had a higher rate of in-hospital mortality (3.3% vs. 0.2%, p<0.01), wound complications (10.6% vs. 6.2%, p<0.01), venous thromboembolism (4.9% vs. 0.8%, p<0.01), blood transfusions (25.3% vs. 7.0%, p<0.01), non-renal major medical complications (40.0% vs. 8.4%), and longer hospital stay (9.2 vs. 3.8 days, p<0.01). Multivariate logistic regression analysis controlling for age, race, sex, hospital type, insurance status and comorbidities, demonstrated that ESRD was independently associated with increased risk of venous thromboembolism (OR 2.38, 95%-CI 1.48–3.83), non-renal major medical complications (OR 1.51, 95%-CI 1.19–1.91), and in-hospital mortality (OR 6.88, 95%-CI 3.50–13.55). ESRD was not independently associated with increased rate of wound complications or blood transfusions. CONCLUSION: ESRD patients present with significant medical comorbidities and experience higher rates of wound, thromboembolic, and medical complications following panniculectomy. After risk-adjustment for demographic factors and comorbidities, ESRD is independently associated with increased risk of thromboembolic and medical complications, as well as perioperative mortality. Plastic surgeons should carefully discuss risks and benefits of panniculectomy with these patients and work in a multidisciplinary fashion to optimize perioperative management.

Simultaneous Native Nephrectomy and Kidney Transplantation in Patients With Autosomal Dominant Polycystic Kidney Disease.

IntroductionTo evaluate the feasibility of simultaneous unilateral nephrectomy with kidney transplantation and to determine the effect of this procedure on perioperative morbidity and mortality and graft and patient survival.MethodsBetween January 2000 and May 2015, 145 patients with autosomal dominant polycystic kidney disease (ADPKD) underwent kidney transplantation. Of those, 40 (27.5%) underwent concurrent ipsilateral native nephrectomy (group NT). Patients in group NT were compared with patients with ADPKD not undergoing concurrent nephrectomy (group NT-) and asymptomatic patients undergoing pretransplant nephrectomy (group PNT).ResultsThe average follow-up was 66 months. The graft survival rate at 1 and 5 years was 95% and 87.5% versus 93% and 76.2% in the NT and NT- groups, respectively (P = .903 and P = .544, respectively); 1-year patient survival was 100% for NT and 97% for NT- patients (P = .288), whereas 5-year patient survival was 100% and 92% for NT and NT- groups, respectively (P = .128). After propensity score matching (34 patients per group) no significant differences were observed in 1-year (97.1% in NT and 94.1%; P = 1) and 5-year (88.2% in NT and 91.2% in NT-; P = 1) graft survival, and in 1-year (100% for both groups; P = 1) and 5-year (100% in NT and 94.1% in NT-; P = 1) patient survival. Perioperative mortality was 0% among NT and 1.2% among NT- patients, whereas perioperative surgical complications were similar in both groups. One- and 5-year graft and patient survival were similar between the NT and PNT groups, but patients in the PNT group had significantly lower levels of hemoglobin and residual diuresis volumes at the time of transplant. Moreover, PNT patients had a longer pretransplant dialysis and a longer time on the waiting list.ConclusionsSimultaneous unilateral nephrectomy does not have a negative effect on patient and graft survival in patients with ADPKD and is associated with low morbidity. Pretransplant nephrectomy should be restricted only to highly symptomatic patients, whereas unilateral nephrectomy in asymptomatic patients should be performed during kidney transplantation only if massive kidney size precludes graft positioning.

Changing USA national trends for adrenalectomy: the influence of surgeon and technique.

To explain differences over time between operative approach and surgeon type for adrenal surgery in the USA. A retrospective cohort analysis was performed on all patients undergoing adrenalectomy between 2002 and 2011 using the Nationwide Inpatient Sample. Patients undergoing concurrent nephrectomy were excluded. Surgeon specialty was only available for 2003-2009. Descriptive analyses and multivariable logistic regression models were used to assess variables associated with minimally invasive surgery (MIS) and urologist-performed procedures. In all, 58,948 adrenalectomies were identified. A MIS approach was used in 20% of these operations. There was a 4% increase in MIS throughout the study period (P < 0.001). Cases performed at teaching hospitals were more likely to be MIS (odds ratio [OR] 1.47, P < 0.001). We were able to identify surgical specialty in 23,746 cases, of which 60% were performed by urologists. Cases performed in the Midwest compared with Northeast were at increased adjusted odds of being performed by urologists (OR 1.38, P = 0.11). Despite most cases being performed by urologists, adrenalectomy by urologists showed a 15% annual decrease over the analysed period (P < 0.001). The use of a MIS technique to perform adrenalectomy is increasing at a slower rate compared with most other surgical extirpative procedures. Further investigation to explain the decreased performance of adrenalectomy by urologists is warranted.

Evaluation of prognostic factors in the surgical treatment of adrenal gland tumors in dogs: 41 cases (1999–2005)

To identify preoperative predictors of survival and assess intraoperative and postoperative complications and survival rates for dogs undergoing adrenalectomy. Retrospective case series. 41 dogs that underwent adrenalectomy. Records were reviewed to collect data regarding preoperative variables. Intraoperative and postoperative variables were also recorded. Variables were evaluated for association with survival duration via log-rank analysis for categoric variables and by use of Cox proportional hazards. Median survival times were calculated by use of Kaplan-Meier life table analysis. 9 (22.0%) dogs did not survive to discharge. Intraoperative mortality rate was 4.8%. Overall Kaplan-Meier median survival time was 690 days. Variables significantly associated with shorter survival times included preoperative weakness or lethargy, thrombocytopenia, increased BUN concentration, increased partial thromboplastin time (PTT), increased aspartate transaminase (AST) activity, hypokalemia, intraoperative hemorrhage, and concurrent nephrectomy. Postoperative variables significantly associated with shorter survival times included pancreatitis and renal failure. In multivariate analysis, preoperative hypokalemia, preoperative increased BUN concentration, and concurrent nephrectomy were significantly associated with a shorter survival time. A high mortality rate was associated with adrenalectomy in dogs; however, those that survived until discharge from a hospital had long survival times. Preoperative factors associated with a shorter survival time were weakness or lethargy, thrombocytopenia, increased BUN concentration, increased PTT, increased AST activity, and hypokalemia. Studies are needed to evaluate how treatment for these factors may affect or change outcome after adrenalectomy. Dogs with adrenal masses that require concurrent nephrectomy and cause intraoperative hemorrhage have a guarded prognosis.

Selective, Concurrent Bilateral Nephrectomies at Renal Transplantation for Autosomal Dominant Polycystic Kidney Disease

An algorithm was developed for performing bilateral nephrectomies for specific indications before or at renal transplantation in patients with autosomal dominant polycystic kidney disease. Outcomes for the living donor arm of the algorithm are reported. Patients with autosomal dominant polycystic kidney disease and end stage renal disease were evaluated for transplantation. Patients with recurrent pyelonephritis, hemorrhage, pain, early satiety or kidneys that extended into the true pelvis underwent bilateral nephrectomies. Bilateral nephrectomies with concurrent renal transplantation were performed if a living renal donor was identified. If no living donor was identified, pre-transplantation bilateral nephrectomies were done and the patients were listed for cadaveric donor renal transplantation. The living renal donor arm of the algorithm was evaluated by comparing certain parameters for 15 and 17 patients with autosomal dominant polycystic kidney disease who underwent pre-transplantation and concurrent bilateral nephrectomies, respectively, including patient and graft survival, delayed graft function, graft function, length of stay for each surgery, transfusions and complications. No deaths, graft failures or delayed graft function occurred. In the delayed renal transplant group median time from nephrectomy to living donor transplantation was 124 days. Serum creatinine at discharge home and 1 year after transplantation for the pre-transplantation nephrectomy cohort was 2.0 and 1.3 mg/dl, respectively. Seven of the 17 patients with concurrent nephrectomy underwent transplantation before starting renal replacement therapy. A longer mean total hospital stay in the pre-transplantation nephrectomy cohort was the only statistically significance outcome variable. Selective bilateral nephrectomies at living donor renal transplantation results in decreased total length of stay without compromising patient or graft outcomes and it allows preemptive renal transplantation. Concurrent nephrectomy is safe and it further validates the algorithm for selective, concurrent bilateral nephrectomies for patients with autosomal dominant polycystic kidney disease who undergo living donor renal transplantation.

Surgical treatment of pheochromocytoma: technique, complications, and results in six dogs.

Six dogs were diagnosed with pheochromocytoma and staged according to the World Health Organization's system for tumor classification. Two dogs had benign tumors (T1, N0, M0) and four dogs had malignant tumors (T2, N0, M1 or T3, N0, M0). All dogs had adrenalectomy, two dogs had concurrent nephrectomy, and three dogs had concurrent resection of a tumor thrombus from the vena cava. Anesthetic complications occurred in five dogs, including wide variations in heart rate (four dogs), blood pressure (five dogs), and cardiac arrhythmias (one dog). One dog died 12 hours after surgery from partial dehiscence of the suture line and hemorrhage from the vena cava, and one dog died 6 days after surgery during general anesthesia for treatment of laryngeal paralysis. Four dogs survived from 3 to 23 months (median, 15 months). One dog remained hypertensive after surgery. Benign and malignant pheochromocytomas seem to be amenable to surgical resection.