Conservative Renal Surgery Research Articles

Predictive Value of Magnetic Resonance Imaging and Computerized Tomography for Conservative Renal Surgery in an Ex Vivo Tumor Enucleation Study Followed by Step-Sectioning

Predictive Value of Magnetic Resonance Imaging and Computerized Tomography for Conservative Renal Surgery in an Ex Vivo Tumor Enucleation Study Followed by Step-Sectioning

Conservative Renal Surgery: Has It a Role in Renal Cell Carcinoma?

Conservative renal surgery is a viable alternative for patients in whom preservation of renal function is important. The long-term survival is similar to that of radical nephrectomy, especially in low-grade malignancies. The technique is unproven in patients with a normally functioning contralateral renal unit, although it may be an option in small, peripheral, low-grade lesions.

Coexisting Lymphangioleiomyomatosis and Bilateral Angiomyolipomas in a Patient with Tuberous Sclerosis

A patient with tuberous sclerosis and known bilateral angiomyolipomas presented with a complete pneumothorax prior to scheduled renal surgery. Evaluation revealed the presence of pulmonary lymphangioleiomyoma, an unusual entity known to coexist with tuberous sclerosis. Pulmonary decortication and conservative renal surgery resulted in a satisfactory long-term result.

Expanding indications for conservative renal surgery in renal cell carcinoma

Objective. To more clearly define the selection criteria for conservative renal surgery in renal cell carcinoma. Method. The survival experience of 42 patients who underwent in situ partial nephrectomy (21), enucleation (18), or both (3) over an eighteen-year period was examined. The presence or a history of contralateral cancer, type of surgery, gender, grade, diameter of tumor, age at diagnosis, presenting symptoms, positive surgical margins, smoking history, and stage were examined with regard to prognostic significance. Results. The five-year cancer-specific survival rates were 100 percent for those patients undergoing partial nephrectomy and 84 percent for those undergoing enucleation. The local recurrence rate was 4.8 percent ( 2 42 ) for the group, with both recurrences occurring in patients with von Hippel-Lindau disease. The mean diameter of tumor resected was 4.2 cm. Those patients found to have a positive surgical margin (6) had a significantly shorter disease-specific survival than those who did not (37) (p = 0.004), and those with a smoking history (23) had a significantly shorter survival than non-smokers (19) (p = 0.038). Conclusions. We conclude that both partial nephrectomy and enucleation are acceptable approaches to renal cell carcinoma in select cases, with survival rates that closely approximate those found in radical nephrectomy series. Renal carcinomas that are peripherally located and small in diameter (≤ 5 cm) are most appropriate for these procedures, and given the excellent results noted to date, the expanded use of these approaches to include very young patients and those with any disease process that may affect renal function is warranted. A positive surgical margin is an ominous pathologic finding and should be avoided by frozen section biopsy at surgery or possibly intraoperative ultrasonography. Additionally, smokers with renal cell carcinoma have a poorer disease-specific survival than non-smokers, further questioning a carcinogenic etiology in this disease.

Conservative Surgery of Renal Cell Tumors in 140 Patients: 21 Years of Experience

Operative method, course and complications were analyzed retrospectively in 140 patients who underwent a conservative operation for renal tumor between June 1969 and December 1990. In 53 patients (20 women and 33 men, mean age 61.2 years, range 38 to 77 years, with 49 renal cell carcinomas and 4 benign renal tumors) there was an imperative indication for an organ preserving operation because nephrectomy would have made dialysis obligatory. In 87 patients (29 women and 58 men, mean age 53.7 years, range 27 to 74 years, with 72 renal cell carcinomas and 15 benign renal tumors) the tumor was conservatively resected in the presence of a normal contralateral unit (elective indication) and 68 of these patients (78%) were symptom-free. In the imperative group 32 of 49 patients (65.3%) with renal cell carcinoma had no evidence of disease after a mean followup of 4.6 years. Known metastases were present in 4 of 7 patients who died of the tumors in this group. In 3 patients with an imperative indication for conservative surgery a second tumor occurred in the kidney: 2 were treated with further parenchyma sparing operations, while in 1 with poor physical condition no further measures were possible. Of 72 patients with renal cell carcinoma who underwent an elective operation 68 (94.4%) had no signs of tumor progression after a mean followup of 3.3 years. One patient died of tumor metastases, and 2 (2.7%) had tumor recurrence in the kidney requiring nephrectomy and enucleation, respectively. The 5-year cause-specific survival rates for the imperative and elective groups were 84% and 96%, respectively. Patients with a local stage T3 tumor were characterized by a significantly worse survival curve than those with a stage T1 or T2 tumor but no significant difference was noted among the various grades of differentiation.

A new method for conservative renal surgery ? experimental and first clinical results

So far two methods for prolonging the tolerance of renal ischemia are available: 1) surface cooling with crushed ice and 2) perfusion cooling with an extracellular-like solution. Both methods use only the principle of reducing metabolism through cooling. While rewarming during surgery the ischemic protection is lost, or the kidney must be cooled once again. Therefore, a new preservation solution should reduce energy consumption due to its composition in addition to cooling. For open heart surgery, the HTK solution by Bretschneider is already used clinically. In 71 dog kidney experiments, the ischemic time kidneys could tolerate was prolonged by this solution from 15 to 120 min at 35 degrees C and from 45 to 360 min at 25 degrees C. After 2 h of ischemia at 30 degrees C glomerular filtration rate was about 20 ml/min.100gww within 3 h of reperfusion. After six postoperative days the filtration rate was 40 ml/min.100 gww. No ischemic damage could be recognized by histological investigations. The clinical effectiveness of this method was shown in 7 clinical applications. Ischemic duration lasted up to 113 min, and blood creatinine was between 0.8 and 2.4 mg% at the 6th postoperative day. Use of this preservation technique thus leads to improved kidney function immediately following operation. Longer ischemia can be tolerated by a kidney thus protected, and using this technique excellent visibility can be achieved during intrarenal surgery, simplifying, for example, tumor extirpation.

Renal preservation utilizing neodymium: Yag laser

Six patients with malignancies in a solitary kidney were treated with conservative renal parenchymal-sparing surgery utilizing the Neodymium Yttrium Aluminum Garnet (Nd: YAG) laser. Three patients had transitional cell carcinoma in an upper pole calyx of a solitary kidney. The transitional cell carcinoma was treated definitively by the Nd: YAG laser through a nephroscope prior to partial nephrectomy. The 3 patients have been followed up for twenty-eight, eighteen, and six months, respectively. None of the patients has shown evidence of recurrent cancer on follow-up retrograde ureterograms or on urine cytology obtained from the renal pelves. Three patients with renal cell carcinoma in a solitary kidney had the tumor surgically excised utilizing the Nd: YAG laser in conjunction with standard surgical techniques. All the patients were elderly with compromised renal vasculature that prevented bench surgery with auto transplantation or occlusion of the renal artery. At sixteen, fourteen, and three months, respectively, there is no evidence of recurrent cancer on CAT scans obtained on these patients.

Diagnosis and treatment of renal angiomyolipoma.

A series of nine patients surgically treated for histologically verified renal angiomyolipoma is presented. Only one patient had extrarenal stigmata of tuberous sclerosis. No evidence of malignancy was found. In three cases a preoperative diagnosis was achieved with computed tomography (CT), use of which is recommended in evaluation of renal tumours. Six angiomyolipomas were solitary and three bilateral. Abdominal or flank pain was present in eight cases and perirenal haemorrhage in four. Solitary tumours were treated with nephrectomy. For bilateral tumour, nephrectomy and conservative renal surgery were used in two cases and bilateral nephrectomy and kidney transplantation were performed in the third case. When adipose tissue containing renal tumour is demonstrated at CT, conservative surgery should be considered.

Management of patients with renal and ureteric calculi presenting with chronic renal insufficiency.

Of 403 patients with renal and ureteric calculi treated during the last 4 years, 64 presented with features of chronic renal insufficiency: 59 of these underwent surgery. Good pre-operative preparation and conservative renal surgery restored normal renal function in 14 patients and 27 improved significantly. The remainder either did not improve or continued to have progressive renal failure. It is emphasised that these patients are considerably worse off compared with their counterparts with normal renal function. The overall mortality rate was 17%. Patients whose post-operative serum creatinine levels did not stabilise to less than 884 mumol/l seemed to make poor progress in the follow-up period.

Conservative renal surgery for adenocarcinoma. The place of bench surgery.

A brief review of reported cases of tumours in solitary kidneys and of bilateral simultaneously occurring tumours is reported. 1 case of bilateral simultaneously occurring tumour ana 3 cases of tumour occurring in solitary kidneys are reported. The treatment of these cases by simple partial nephrectomy under regional hypothermia is described. The palce of ex vivo "Bench Surgery" for this condition is discussed.

Conservative Renal Surgery Associated with Ureteral Stricture Work

No AccessJournal of Urology1 Feb 1923Conservative Renal Surgery Associated with Ureteral Stricture Work1 Guy L. Hunner Guy L. HunnerGuy L. Hunner More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(17)73766-4AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail © 1923 by The American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsCited byKlotz B (2018) A Modified Pyeloplasty for the Correction of Hydronephrosis Due to Extrinsic Obstructions at the Ureteropelvic Junction: A Case ReportJournal of Urology, VOL. 60, NO. 5, (706-711), Online publication date: 1-Nov-1948.Deming C (2018) Ureteropelvic Obstruction due to Extrinsic and Intrinsic Lesions of the Ureter as a Clinical Entity and its TreatmentJournal of Urology, VOL. 50, NO. 4, (420-431), Online publication date: 1-Oct-1943. Volume 9Issue 2February 1923Page: 97-149 Advertisement Copyright & Permissions© 1923 by The American Urological Association Education and Research, Inc.MetricsAuthor Information Guy L. Hunner More articles by this author Expand All Advertisement PDF downloadLoading ...