Normal Contralateral Kidney Research Articles

Incidence of pathologic postobstructive diuresis after resolution of ureteropelvic junction obstruction with a normal contralateral kidney

Postobstructive diuresis (POD) after unilateral pyeloplasty or percutaneous nephrostomy (PCN) tube insertion for ureteropelvic junction obstruction (UPJO) in patients with a normal contralateral kidney is not well described. The objective of this study was to determine the incidence and characteristics of POD after relief of unilateral UPJO in patients with a normal contralateral kidney. Children who underwent a unilateral pyeloplasty or PCN for UPJO from 2010 to 2017 with a normal contralateral kidney were retrospectively reviewed. Postobstructive diuresis was defined as urine output (UO) of >300% of expected UO. Patients with a solitary kidneyor those who underwent bilateral pyeloplasty or bilateral PCN tube placement were excluded. Out of 396 children meeting inclusion criteria, seven (1.8%) developed POD (4 after pyeloplasty and 3 after PCN tube placement). Median age at intervention was 1.7 years (range 11 days-18 years); median weight was 11.4kg (range 3.7-54.2kg). Postobstructive diuresis was more likely to occur in patients with grade 4 hydronephrosis (3.0%) and larger kidneys and if a PCN tube was placed before pyeloplasty. There was no significant difference in age, gender, kidney laterality, or function between those who developed POD and those who did not. Postobstructive diuresis was managed with additional intravenous fluids and electrolyte monitoring. Median initial postprocedure UOwas 5.9mg/kg/hr (range 3.2-10.0mg/kg/hr). In five children who underwent PCN in whom UOcould be differentiated between kidneys, median initial postprocedure UOwas 6.1mg/kg/hr (range 2.5-9.1mg/kg/hr) from the affected side and 0.8mg/kg/hr (range 0.4-0.9mg/kg/hr) from the unaffected side. The median length of time to resolution of POD was 3 days (range 2-4 days). One patient developed significant acidosis and lethargy that improved with intravenous fluid management. Mild hyponatremia developed in two, hypokalemia in one, hypophosphatemia in one, acidosis in one, and hypoglycemia in 1 patient. A low but clinically significant risk of POD occurring after relief of unilateral UPJO in children with a normal contralateral kidney is described. Limitations include retrospective analysis and small sample size due to the rarity of the condition. Postobstructive diuresis after decompression of UPJO in patients with a normal contralateral kidney is a rare event (1.8%). However, POD does occur, and patients should be carefully monitored after these procedures given the potential for significant dehydration and electrolyte disturbances.

Shear Wave Elastography in the Evaluation of the Kidneys in Pediatric Patients with Unilateral Vesicoureteral Reflux.

To evaluate the ability of shear wave elastography (SWE) to detect renal parenchymal scar formation in patients with vesicoureteral reflux. We prospectively evaluated 49 patients with unilateral grade 2 or higher-degree VUR. All patients underwent dimercaptosuccinic acid (DMSA) scintigraphy for evaluation of the renal parenchymal scar. After the DMSA scan, 2 radiologists, who were blinded to clinical data and each other's measurements, evaluated the kidneys of the patients using SWE. The kidneys were divided into 3 parts: upper pole, middle region, and lower pole, and 3 regions of interest were placed to each part. Shear wave velocity (SWV) values were calculated using meters per second as a unit and recorded for each region. Afterward, SWV values were compared to DMSA results. There was no significant difference between the observers' mean SWV values of kidneys with VUR without scar formation (mean ± SD, 2.11 ± 0.06 and 2.09 ± 0.05 m/s) and the contralateral normal kidney SVW values (2.11 ± 0.06 and 2.10 ± 0.05 m/s; P = .936 and .724, respectively). We observed a significant difference between the mean SWV values of the kidneys with VUR accompanied by scar formation (2.28 ± 0.10 and 2.27 ± 0.11 m/s) and the mean SWV values of the contralateral normal kidneys (2.09 ± 0.05 and 2.10 ± 0.04 m/s; P < .001 for both observers). Shear wave elastography could detect scar tissue in kidneys; however, the variability of the stiffness due to the kidney's complex structure, and variations in blood perfusion and the glomerular filtration rate of the kidney might limit the use of SWE in current clinical diagnostic algorithms for VUR.

Renal Impairment in Young Patients with Unilateral Ureteral Lithiasis Obstruction: What Factors can be Responsible?

In the literature, occurrence of acute kidney injury (AKI) in young patients with unilateral ureteral lithiasic obstruction and without previous renal impairment is not very often reported, and the underlined pathophysiological mechanisms are poorly known; according to some studies, it is a false kidney failure, the increase in serum creatinine being due to absorbtion of obstructed urine in the affected kidney. We have conducted a retro and prospective study in order to identify the possible risk factors that can cause renal function impairment in young patients (18-40 years) with unilateral ureteral lithiasis obstruction and a normal contralateral kidney. Results. From 402 patients included in the study, 20.64% (83 cases) presented with serum creatinine ] 1.3 mg/dL. In patients with renal impairment, prevalence of male gender and history of NSAIDS use before admission were significantly higher than in non-AKI group. Serum urea/creatinine ratio, and estimated glomerular filtration rate (MDRD formula) were significantly higher, and respectively lower in AKI group. We found no significant differences between the two groups regarding age, prevalence of urinary tract infection after relief of obstruction, C-reactive protein value, and the duration of hospitalization. Conclusions. AKI in young patients with unilateral ureteral lithiasis obstruction and normal contralateral kidney is not quite a rare finding in our region. NSAIDs use can influence development of AKI, and should be used cautiously even in young patients with renal colic. In our opinion, the presence of AKI in patients with unilateral hydronephrosis demands urgent endourological intervention. Choosing conservative therapy in these patients, especially treatment with NSAIDS may aggravate the renal dysfunction.

Usefulness of Apparent Diffusion Coefficient of Diffusion-Weighted Imaging for Differential Diagnosis of Primary Solid and Cystic Renal Masses.

SummaryBackgroundTo evaluate the value of diffusion-weighted imaging (DWI) for distinguishing between benign and malignant renal masses.Material/MethodsSeventy-five patients with 75 unilateral renal lesions were included, and 75 normal contralateral kidneys served as controls. The lesions were categorized into four groups as malignant cystic, malignant solid, benign cystic and benign solid. The apparent diffusion coefficients (ADCs) were evaluated for two different b values (b=600 s/mm2 and b=1000 s/mm2). Receiving operating characteristic analysis was performed to identify threshold ADCs.ResultsSensitivity and specificity were 67% and 77% (p=0.003) at the cutoff value of 1.5 for b=600 s/mm2, and 79% and 62% (p=0.004) at the cutoff value of 1.99 for b=1000 s/mm2 as regards the differentiation between solid benign and malignant renal lesions. Sensitivity and specificity were 78% and 79% (p=0.001) at the cutoff value of 3.1 for b=600 s/mm2, and 86% and 61% (p=0.003) at the cutoff value of 2.9 for b=1000 s/mm2 as regrads the differentiation between benign and malignant cystic renal lesions.ConclusionsDWI can be an effective diagnostic method for distinguishing between benign and malignant renal masses.

Experience with Renal Autotransplantation: Typical and Atypical Indications.

Introduction and Objectives Renal autotransplantation is a kidney-saving surgical procedure used in selected patients. The purpose of this report is to review nine typical and atypical indications for kidney autotransplantation and evaluate its effectiveness in maintaining kidney function and avoiding cancer recurrence. Materials and Methods From 1999 till 2014, nine renal autotransplantations were performed in our center. A retrospective case review was done. Four of nine patients had a solitary functioning kidney. Typical indications for autotransplantation included extended ureteric disease in 5 patients, intrasinusal tumor on a solitary kidney in 1 patient, and renal artery aneurysm in 1 patient. Atypical indications consisted in bilateral urothelial tumors in 1 patient and interrupted live kidney transplantation in 1 patient. Mean cold ischemia time was 209 minutes. Demographic factors, indications, renal function before and after surgery, and in the long term, cancer recurrence and disease-free survival were evaluated. Results Renal function was maintained in 8 patients during the early follow-up. No serious complications occurred in the postoperative period. Median duration of follow-up was 50 months. In 4 patients with a normal contralateral kidney, mean preoperative and at discharge creatinine clearance were 105.45 ml/min and 121.02 ml/min, respectively. Although values showed an improvement in the kidney function, the difference was not significant (p value 0.3). In the other 4 patients with a solitary kidney, mean discharge creatinine clearance was 99.24 ml/min surprisingly higher than the preoperative value 96.92 ml/min. At the last follow-up, kidney function was preserved for the two groups (normal contralateral kidney/solitary kidney) with relatively stable creatinine clearance values: 108.45 ml/min and 85.9 ml/min, respectively. No patients required secondary dialysis. Conclusion Renal autotransplantation is a rare, safe, and effective surgical procedure for the treatment of complex urologic conditions. In some instances, it may be of great utility for kidney salvage in some carefully selected patients.

Preoperative scoring systems used in retroperitoneoscopic partial nephrectomy for T1-T2 renal tumors

Introduction. P.A.D.U.A. (The preoperative aspects and dimensions used for anatomic), R.E.N.A.L. (radius exophytic/endophytic nearness anterior/posterior location) and zonal NePhRO scoring were developed in an effort to predict the intraoperative (warm time ischemia, blood loss) and postoperative complications in patients undergoing partial nephrectomy, with an important role on surgical decision-making (2-4). Materials and methods. Between January 2014 and July 2017, 37 patients(p) underwent retroperitoneoscopic nephro-sparing surgery at our center for clinically localized renal tumor. All patients had a normal contralateral kidney. The selection of patients for nephro-sparing surgery was based on preoperative CT scan, location of the tumor, the individual general health status of the patient and individual surgeon preferences. A chart review was carried out, including age, sex, anatomic preoperative scoring system (P.A.D.U.A., R.E.N.A.L. nephrometry and zonal NePhRO), operative time (skin opening to skin closing), estimated blood loss (EBL), warm ischemia time (WIT), hospital stay. Results. The mean age of patients with partial nephrectomy was 54.3±9.1 years. Mean preoperative serum creatinine level for the patient group was 0.97±0.14 mg/dl. All patients had normal contralateral kidney. Average tumor diameter in this group was 3.6± 0.86 cm. When using P.A.D.U.A. score to predict warm time ischemia p value was of 0.001, even if the mean warm ischemia time is higher in medium risk patients than in high risk patients 24.3 min vs. 23.2 min. R.E.N.A.L. nephrometry score was able to predict the warm ischemia time according to the risk groups (17.6 vs. 23.9 vs. 31 min) with a p value under 0.001. Zonal NePhRO score was statistically correlated with total operative time, blood loss, warm ischemia and renal function decrease, all with a p value &lt; 0.05. Conclusion. P.A.D.U.A. score, R.E.N.A.L. nephrometry score and Zonal NePhRO score have proved to be reliable preoperative tools in order to evaluate surgical complexity and to predict outcomes such as warm time ischemia, blood loss, postoperative estimated GFR and complications rate.

Qualitative and quantitative radiological analysis of non-contrast CT is a strong indicator in patients with acute pyelonephritis

ObjectiveTo evaluate the performance of non-contrast computed tomography (CT) by reporting the difference in attenuation between normal and inflamed renal parenchyma in patients clinically diagnosed with acute pyelonephritis (APN). Material and methodsThis is a retrospective study concerned with non-contrast CT evaluation of 74 patients, admitted with a clinical diagnosis of APN and failed to respond to 48h antibiotics treatment. Mean attenuation values in Hounsfield units (HU) were measured in the upper, middle and lower segments of the inflamed and the normal kidney of the same patient. Independent t-test was performed for statistical analysis. Image evaluation included receiver operating characteristic (ROC), visual grading characteristic (VGC) and kappa analyses. ResultsThe mean attenuation in the upper, middle and lower segments of the inflamed renal cortex was 32%, 25%, and 29% lower than the mean attenuation of the corresponding cortical segments of the contralateral normal kidney, respectively (p<0.01). The mean attenuation in the upper, middle, and lower segments of the inflamed renal medulla was 48%, 21%, and 30%, lower than the mean attenuation of the corresponding medullary segments of the contralateral normal kidney (p<0.02). The mean attenuation between the inflamed and non-inflamed renal cortex and medulla was 29% and 30% lower respectively (p<0.001). The AUCROC (p<0.001) analysis demonstrated significantly higher scores for pathology detection, irrespective of image quality, compared to clinical and laboratory results with an increased inter-reader agreement from poor to substantial. ConclusionNon-contrast CT showed a significant decrease in the parenchymal density of the kidney affected with APN in comparison to the contralateral normal kidney of the same patient. This can be incorporated in the diagnostic criteria of APN in NCCT in the emergency setting.

EP12.23: Application of 3D multislice ultrasound in analysis of fetal urinary tract abnormalities

To evaluate 3D multislice ultrasound technology in detection of fetal urinary tract anomalies. 50 patients with fetal urinary tract anomalies were included in this study. Fetuses were scanned in 2D, and 3D multislice technique, prior to confirming the urinary tract abnormality. Fetal kidneys and bladder were analysed in all 3 planes in 3D multislice mode in order to confirm urinary tract anomaly. In one patient bilateral renal and bladder agenesis was detected, associated with other severe anomalies as hydrocephalus, cleft lip, oligoamnion and single umbilical artery. Kariotyping confirmed triploidy. Two fetuses had marked megavesica. Four fetuses had multiple anomalies including microcystic kidneys associated with Trisomy 13 and trisomy18. Five fetuses had multicystic dysplastic kidneys, and one of them had multicystic kidney with contralateral renal and bladder agenesis. One fetus had unilateral renal agenesis with normal contralateral kidney. Seven fetuses had ureteral stenosis and marked hydronephrosis with contralateral normal kidney. 30 fetuses had marked pyelectasia in second trimester. In one case there was progression from pyelectasia to unilateral hydronephrosis. Kariotyping in fetuses where pyelectasia occurred in second trimester showed no abnormality. 3D multislice ultrasound may improve diagnostic capabilities of ultrasound in detection of fetal urinary tract anomalies. 3D multislice allowed morphological analysis of fetal kidneys in various planes in order to obtain the best section for final diagnosis.

Risk Assessment for Complications of Partial Nephrectomy – Comparative Study between Retroperitoneoscopic Approach and Open Surgery

Introduction. Partial nephrectomy represent the standard of care for small renal tumor. Laproscopic approach tends to replace open surgery due to similar oncologic results, but with better eastethic outcomes and earlier socio-professional reintegration. Material and methods. Between January 2010 and February 2017, 55 patients (p) underwent partial nephrectomy at our center for clinically localized renal tumor, 21p with LPN by retroperitoneal approach and 34p with OPN. All patients had a normal contralateral kidney. The selection of patients for nephron-sparing surgery was based on preoperative CT scan, location of the tumor, the individual general health status of the patient and individual surgeon preferences. Results. The mean age of patients with partial nephrectomy was 59.6±16.4 years, with 57.9±11.6 years for laparoscopic subgroup and 61.3±12.4 for open surgery. The transfusion rate was 9.52% in LPN group, while in the OPN there was no need for transfusion. The warm ischemia time was higher in the LPN group (21.8±7.2 min) than OPN group (15.7±2.9). The postoperative complication rate is comparable between LPN and OPN (23.81% v.s. 20.58%), but the LPN had higher intraoperative complications. Conclusion. Laparoscopic partial nephrectomy for renal tumors is superior to open surgery by early mobilization of the patient, the low rate of wound complications, short duration of hospitalization, fast socio-professional reintegration of patient, despite the perioperative complication rate that is higher but of low ClavienDindo grade.

The effect of predisposing atheroembolic risk factors on renal functional recovery between laparoscopy and open technique in patients with T1-stage renal cell carcinoma who underwent partial nephrectomy: a retrospective comparison study.

The present study aimed to determine the effect of an increasing number of predisposing atheroembolic risk factors on the development of chronic kidney disease (CKD) after partial nephrectomy (PN) in patients with T1-stage renal cell carcinoma (RCC). The study included 147 patients with T1-stage RCC with a normal contralateral kidney and without preoperative CKD, who underwent open (OPN, N = 83, 56.5%) or laparoscopic PN (LPN, N = 64, 43.5%) between 2003 and 2014. Postoperative CKD was defined as an estimated glomerular filtration rate <60 ml/min/1.73 m2. The predictive factors for CKD between OPN and LPN were statistically assessed among various known clinicopathological factors associated with renal function in PN with a significance of two-sided P value <0.05. During a median follow-up of 42 months, the recurrence rate was 0.7% (n = 1), and the rate of postoperative CKD was 11.6% (n = 17). Significant differences in CKD-free survival were observed among patients with atheroembolic risks 5-7, 3-4 and 1-2 (P = 0.027). Regarding the predictive factors for the postoperative development of CKD between OPN and LPN, a predisposing atheroembolic risk ≥3 was significant among other clinicopathological factors in multivariate analysis (hazard ratio, 3.007, P = 0.031). Patients with T1-staged RCC with ≥3 predisposing atheroembolic risk factors have a significantly higher risk of developing CKD after PN. Patients who underwent LPN had a lesser incidence of CKD development than patients who underwent OPN with ≥3 predisposing atheroembolic risk factors.

Exploratory Subgroup Analyses of Renal Function and Overall Survival in European Organization for Research and Treatment of Cancer randomized trial of Nephron-sparing Surgery Versus Radical Nephrectomy

BackgroundIn the European Organization for Research and Treatment of Cancer (EORTC) randomized trial 30904, nephron-sparing surgery (NSS) reduced the risk of renal dysfunction compared with radical nephrectomy (RN); however, overall survival was better in the RN arm. ObjectiveTo determine whether treatment effect on the risk of renal dysfunction and all-cause mortality differed in magnitude across levels of baseline variables. Design, setting, and participantsThis was an exploratory subgroup analysis of EORTC 30904, a phase 3 randomized trial conducted in patients with a small (≤5cm) renal mass and normal contralateral kidney. InterventionPatients were randomized to RN (n=273) or NSS (n=268). Outcome measurements and statistical analysisEnd points included follow-up estimated glomerular filtration rate (eGFR) <60ml/min/1.73m2, eGFR <45ml/min/1.73m2, eGFR <30ml/min/1.73m2, and all-cause mortality. Treatment effect was examined within baseline variables: age (<62 vs ≥62 yr), sex, chronic disease (any vs none), performance status (0 vs≥1), and serum creatinine ≤1.25 vs >1.25×upper limit of normal (ULN). Logistic and Cox regression models were used for analysis of renal dysfunction and all-cause mortality, respectively. Results and limitationsThe median follow-up periods were 6.7 yr for eGFR and 9.3 yr for survival. No variable-by-treatment interactions were significant at alpha=0.05. For patients with baseline creatinine >1.25×ULN (n=36), estimated mortality hazard ratio (HR) for NSS versus RN reversed its direction (HR=0.76, 95% confidence interval [CI]: 0.17–3.39) relative to the rest of the study cohort (HR=1.56, 95% CI: 1.06–2.29), although this reversal was not statistically significant (interaction p=0.25). This analysis was limited by low power. ConclusionsThis exploratory analysis did not reveal strong evidence of treatment effect modification in EORTC 30904, but it was limited by low power. Patient summaryWe aimed to determine whether the effect of partial versus radical nephrectomy on kidney function and overall survival depended on age, sex, and baseline health of patients enrolled in a large clinical trial. Such dependence could not be demonstrated in this analysis.

Ischemia and Functional Recovery from Partial Nephrectomy: Refined Perspectives

BackgroundNephron mass preservation is a key determinant of functional outcomes after partial nephrectomy (PN), while ischemia plays a secondary role. Analyses focused specifically on recovery of the operated kidney appear to be most informative, yet have only included limited numbers of patients. ObjectiveTo evaluate the relative impact of parenchymal preservation and ischemia on functional recovery after PN using a more robust cohort allowing for more refined perspectives about ischemia. Design, setting, and participantsA total of 401 patients managed with PN with necessary studies were analyzed for function and nephron mass preserved specifically within the kidney exposed to ischemia. InterventionPN. Outcome measurements and statistical analysisThe nephron mass preserved was measured from computed tomography scans <2 mo before and 3–12 mo after PN. Patients with two kidneys were required to have nuclear renal scans within the same timeframes. Recovery from ischemia was defined as the percent function preserved normalized by the percent nephron mass preserved. Pearson correlation was used to evaluate relationships between functional recovery and nephron mass preservation or ischemia time. Multivariable linear regression assessed predictors for recovery from ischemia. Results and limitationsThe median tumor size was 3.5cm and the median RENAL score was 8. Cold and warm ischemia were utilized in 151 and 250 patients, and the median ischemia time was 27 and 21min, respectively. The function preserved was strongly correlated with nephron mass preserved(r=0.63; p<0.001). Median recovery from ischemia was significantly higher for hypothermia (99% vs 92%; p<0.001) and remained consistently strong even with longer duration. Multivariable analysis demonstrated that recovery from ischemia, which normalizes for nephron mass preservation, was significantly associated with ischemia type and duration (both p<0.05). However, each additional 10min of warm ischemia was associated with only a 2.5% decline in recovery from ischemia. Limitations include the retrospective design. ConclusionsOur data suggest that functional recovery from clamped PN is most reliable with hypothermia. Longer intervals of warm ischemia are associates with reduced recovery; however, incremental changes are modest and may not be clinically significant in patients with a normal contralateral kidney. Patient summaryFunctional recovery after clamped partial nephrectomy is primarily dependent on preservation of nephron mass. Recovery is most reliable when hypothermia is applied. Longer intervals of warm ischemia are associated with reduced recovery; however, the incremental changes are modest.

Doppler sonography in acute renal obstruction and role of intra venous urography: a study in a tertial care centre

Background: Arterial RI measurements by duplex Doppler USG have been advocated for the diagnosis of obstruction. In most centres, obstruction is indicated by an RI greater than 0.70 or a difference of greater than 0.10 between the kidneys. Our aim was to evaluate and compare the Doppler waveform alterations in unilateral acute renal obstruction (UARO) with the contralateral normal kidney as a control. Methods: 100 patients presenting to the emergency medical division with symptoms of unilateral acute renal colic were subjected to USG and Doppler USG. The renal RI was calculated in comparison to the collateral normal kidney. Results: The mean resistivity index (RI) was higher in obstructed kidneys in all cases. 80% patients had complete, while 20% had partial obstruction. RI value in completely obstructed kidneys was 0.72 versus 0.71; p<0.05. However, even in partially obstructed kidneys, RI was significantly higher than in the contralateral (unobstructed) kidney. The diagnostic accuracy of the Doppler was 96% sensitive in the complete obstruction cases and 85% in patients with partial obstruction. Conclusions: Doppler USG is a useful diagnostic tool in unilateral acute renal obstruction, with RI values being significantly higher in patients with complete obstruction than in patients with partial obstruction.

Nephron Sparing for Renal Cell Carcinoma: Whenever Possible?

Open studies have definitely and repeatedly favoured nephron-sparing surgery in improving overall, cancer-specific, and cardiac disease-specific survival in cases with a normal contralateral kidney. However, the only randomised clinical trial could not confirm this superiority of nephron-sparing surgery over radical nephrectomy.

Suprapubic-assisted laparoendoscopic single-site nephrectomy: analysis of learning curve in one center

Objective To evaluate the learning curve of Suprapubic-assisted laparoendoscopic single-site surgery (SA-LESS) nephrectomy in our center. Methods From April 2013 to April 2016, 60 patients underwent SA-LESS nephrectomy performed by two associate chief physicians (group B and C, 30 patients in both groups). There were 25 males and 5 females with mean age (48.4±9.4)years in group B, and 23 males and 7 females with mean age (52.6±12.0)years in group C. Operative time, estimated blood loss, converting to conventional laparoscopy or open surgery, intra and postoperative complications in both groups were recorded , The data from both group B and C were compared with those of group A [Standard group with 30 patients who underwent SA-LESS nephrectomy performed by a skillful chief physician, 26 males and 4 females with mean age (50.8±12.3)years]. All the patients in the three groups were diagnosed with upper urinary tract calculus or ureteral stricture with severe ipsilateral hydronephrosis (no-function kidney) and a normal contralateral kidney. The sum of the Cumulative Summation(CUSUM)was also cumulated. Individual learning curve and total learning curve were established. Result All the 30 procedures in group A were successfully completed with an average operative time [(123.3±28.4)min(85~175 min)] and an average estimated blood loss[(121.7±43.1)ml(65~280 ml)]. There were 28 procedures successfully finished in group B and 29 in group C, respectively. The average operative time was [(141.7±49.4)min(90~260 min)] and the average estimated blood loss was [(165.2±81.9)ml(70~450 ml)] in group B, and the average operative time was [(133.1±33.7)min(90~235 min)]and the average estimated blood loss was [(140.0±72.3)ml(75~500 ml)] in group C. There was 1 case converted to conventional laparoscopy and 1 case converted to open surgery in group B with 4 (13.3%) complications (Satava Ⅰ 2 cases, Satava Ⅱ 1 case, Clavien-Dindo Ⅰ 1 case) in all. There was 1 case converted to conventional laparoscopy in group C with 4 (13.3%) complications (Satava Ⅰ 1 case, Satava Ⅱ 2 cases, Clavien-Dindo Ⅱ 1 case) in all. Statistical analysis showed that the number corresponding to the slope changed into negative was 15 and 11 for group B and C, respectively, and 13 was confirmed in the total learning curve. Conclusions SA-LESS nephrectomy could be feasible and safe for an experienced laparoscopic surgeon, who may master it after he finished 13 cases of SA-LESS nephrectomy. Key words: Laparoendoscopic single-site surgery; Nephrectomy; Learning curve; Cumulative summation

MP41-08 COMPARISON OF PERIOPERATIVE OUTCOMES WITH OR WITHOUT RENORRHAPHY IN OPEN PARTIAL NEPHRECTOMY: A PROPENSITY SCORE-MATCHED STUDY

You have accessJournal of UrologyKidney Cancer: Localized: Surgical Therapy I1 Apr 2016MP41-08 COMPARISON OF PERIOPERATIVE OUTCOMES WITH OR WITHOUT RENORRHAPHY IN OPEN PARTIAL NEPHRECTOMY: A PROPENSITY SCORE-MATCHED STUDY Hidekazu Tachibana, Toshio Takagi, Junpei Iizuka, Tsunenori Kondo, and Kazunari Tanabe Hidekazu TachibanaHidekazu Tachibana More articles by this author , Toshio TakagiToshio Takagi More articles by this author , Junpei IizukaJunpei Iizuka More articles by this author , Tsunenori KondoTsunenori Kondo More articles by this author , and Kazunari TanabeKazunari Tanabe More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.175AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES To preserve renal function after partial nephrectomy, various renorrhaphy techniques have been presented. However, any renorrhaphy technique may damage intraparenchymal vessels and compress the renal parenchyma, which may lead to renal artery pseudoaneurysm or vascularized parenchymal volume reduction. We therefore adopted a non-renorrhaphy technique in 2012 to avoid these issues. Using propensity score matching, we compared surgical outcomes of the non-renorrhaphy and renorrhaphy techniques for open partial nephrectomy for T1a renal tumors. METHODS We retrospectively analyzed data from 159 patients with normal contralateral kidneys who underwent open partial nephrectomy for T1a renal tumors and pre- and postoperative enhanced computed tomography between 2012 and 2015. Patient variables, including age, sex, body mass index, presence of hypertension and/or diabetes mellitus, performance status, tumor size, RENAL nephrometry score, and preoperative estimated glomerular filtration rate (eGFR), were adjusted using 1:1 propensity score matching between the renorrhaphy and non-renorrhaphy groups. For the renorrhaphy technique, we coagulated the surface of the resected renal parenchyma with monopolar soft coagulation after pressing a TachoSil tissue-sealing sheet on the resected bed for 10 minutes. RESULTS We matched 43 patients per group. Operative time, estimated blood loss, cold ischemic time, and postoperative hospital stay were not significantly different between the groups. Urine leakage occurred in 9 non-renorrhaphy cases and 1 renorrhaphy case (2.3% vs. 20%, P = 0.02). Renal artery pseudoaneurysm (RAP) occurred in 6 renorrhaphy cases but in 0 non-renorrhaphy cases (13% vs. 0%, P = 0.02). Postoperative eGFR decreased significantly less in the non-renorrhaphy group than in the renorrhaphy group (-11% vs. -1.5%, P = 0.04). CONCLUSIONS Despite the risk of urine leakage, the non-renorrhaphy technique compared to the renorrhaphy technique resulted in a lower risk of RAP and better preservation of eGFR for T1a renal tumors. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e562-e563 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Hidekazu Tachibana More articles by this author Toshio Takagi More articles by this author Junpei Iizuka More articles by this author Tsunenori Kondo More articles by this author Kazunari Tanabe More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

MP58-14 NEUTROPHIL GELATINASE-ASSOCIATED LIPOCALIN (NGAL) AS A BIOMARKER OF RENAL INJURY IN PATIENTS WITH URETERIC STONES

You have accessJournal of UrologyStone Disease: Basic Research & Pathophysiology I1 Apr 2016MP58-14 NEUTROPHIL GELATINASE-ASSOCIATED LIPOCALIN (NGAL) AS A BIOMARKER OF RENAL INJURY IN PATIENTS WITH URETERIC STONES Marco Bolgeri, Khaled Farrag, Antonio Reche, Padmini Manghat, and Seshadri Sriprasad Marco BolgeriMarco Bolgeri More articles by this author , Khaled FarragKhaled Farrag More articles by this author , Antonio RecheAntonio Reche More articles by this author , Padmini ManghatPadmini Manghat More articles by this author , and Seshadri SriprasadSeshadri Sriprasad More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.812AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES An accurate assessment of the risk of renal injury in the patient presenting with renal colic is challenging. Creatinine and urine output measurement have significant pitfalls in patients with normal contralateral kidneys. A biomarker of renal injury may offer the opportunity for early detection and aid clinical management. NGAL has shown good performance in the prediction of renal injury in several clinical scenarios. Our objective was to analyze the kinetics of NGAL in patients presenting with acute ureteric obstruction secondary to stone. METHODS Serum (sNGAL) and urine (uNGAL, normalized to urinary creatinine) levels were measured pre-, intra- and postoperatively in 37 subjects with acute ureteric colic, and compared with two control groups (13 patients with non-obstructive renal stones undergoing elective surgery and 10 healthy controls). Samples were analyzed with the NGAL Test (Bioporto Diagnostics, Denmark) a commercially available particle-enhanced turbidometric immunoassay. Uni- and multivariate analyses were conducted to evaluate correlation of NGAL levels with commonly adopted clinical parameters. RESULTS Levels of sNGAL decreased significantly after relief of ureteric obstruction (77ng/mL vs 82ng/mL, p=0.01), whereas uNGAL increased. uNGAL levels in the urine from the obstructed kidney were significantly higher than in the bladder (p=0.003). In patients who passed their stone, at a median 4 weeks follow-up NGAL levels were significantly lower (p=0.03). NGAL levels at presentation were significantly lower in healthy controls (p=0.003). In controls undergoing elective surgery, pre- and post-operative levels of pNGAL and uNGAL were not significantly different (p=0.61 and p=0.09) On multivariate analysis female gender and a higher white cell count were the only factors correlated with higher NGAL levels. CONCLUSIONS To our knowledge this is the first study evaluating the kinetics of NGAL at different time points in patients with obstruction due to ureteric stones. Relief of obstruction led to a significant decrease in sNGAL levels, though with a brief increase in urinary levels due to release of NGAL-rich urine from the obstructed side. Surgical intervention did not act as a confounder. These observations suggest that this biomarker could help estimating renal injury due to obstructive stones and help as a marker of de-obstruction during follow-up. Further studies are needed to establish the long-term significance of such subclinical renal injury and better define the potential role of NGAL in the clinical decision-making. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e781-e782 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Marco Bolgeri More articles by this author Khaled Farrag More articles by this author Antonio Reche More articles by this author Padmini Manghat More articles by this author Seshadri Sriprasad More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

MP41-09 ASSESSMENT OF SURGICAL OUTCOMES OF THE NON-RENORRHAPHY TECHNIQUE IN OPEN PARTIAL NEPHRECTOMY FOR =T1B RENAL TUMORS

You have accessJournal of UrologyKidney Cancer: Localized: Surgical Therapy I1 Apr 2016MP41-09 ASSESSMENT OF SURGICAL OUTCOMES OF THE NON-RENORRHAPHY TECHNIQUE IN OPEN PARTIAL NEPHRECTOMY FOR =T1B RENAL TUMORS Toshio Takagi, Tsunenori Kondo, Kenji Omae, Junpei Iizuka, Hirohito Kobayashi, Yasunobu Hashimoto, and Kazunari Tanabe Toshio TakagiToshio Takagi More articles by this author , Tsunenori KondoTsunenori Kondo More articles by this author , Kenji OmaeKenji Omae More articles by this author , Junpei IizukaJunpei Iizuka More articles by this author , Hirohito KobayashiHirohito Kobayashi More articles by this author , Yasunobu HashimotoYasunobu Hashimoto More articles by this author , and Kazunari TanabeKazunari Tanabe More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.176AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Renorrhaphy technique is a standard method to adapt renal parenchyma in partial nephrectomy (PN). However, adapting the renal parenchyma into a suitable shape without damaging vessels in cases of large renal tumors located at the renal hilum can be challenging, which has potential to reduce vascularized parenchymal mass. We assessed surgical outcomes between the non-renorrhaphy and renorrhaphy techniques in open partial nephrectomy for ≥ T1b renal tumors using volumetric studies. METHODS We retrospectively analyzed the records of 91 patients with normal contralateral kidneys who underwent both open PN for ≥T1b renal tumors and pre- and postoperative enhanced computed tomography between 2010 and 2014. Volumetric studies to assess vascularized parenchymal volume of the operated kidney were performed within 2 months preoperatively and 6 months postoperatively. Using the non-renorrhaphy technique, hemorrhagic areas on the surface of the renal parenchyma were coagulated by using monopolar soft-coagulation, while a TachoSil® tissue-sealing sheet was placed on the resected bed. RESULTS A total of 50 patients underwent renorrhaphy and 41 patients underwent non-renorrhaphy. Patient backgrounds and R.E.N.A.L Nephrometry scores were not significantly different between the two groups. Cold ischemia time was significantly longer in the renorrhaphy than in the non-renorrhaphy (52min vs. 42min, p=0.0162). However, significant differences were not observed in the preservation rate of the vascularized parenchymal mass in the operated kidney (renorrhaphy,71%:non-renorrhaphy,70%, p=0.5054) and global kidney function (renorrhaphy,88%: non-renorrhaphy,90%, p=0.3653) between the two groups. Age is the only predictor for global kidney function preservation (table). Renal artery pseudoaneurysm occurred in two cases in both groups. Urinary fistula tended to occur more frequently in non-renorrhaphy (2 cases) than in renorrhaphy (5 cases), though this difference was not statistically significant (p=0.237). CONCLUSIONS The non-renorrhaphy technique failed to show a benefit in the preservation of vascularized parenchymal mass of the operated kidney and global renal function for ≥T1b renal tumors compared to the renorrhaphy technique. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e563 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Toshio Takagi More articles by this author Tsunenori Kondo More articles by this author Kenji Omae More articles by this author Junpei Iizuka More articles by this author Hirohito Kobayashi More articles by this author Yasunobu Hashimoto More articles by this author Kazunari Tanabe More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

MP19-06 PREOPERATIVE RADIOLOGIC ASSESSMENT FOR PERINEPHRIC FAT INVASION (T3A): COMPARISON WITH PATHOLOGICAL STAGING

You have accessJournal of UrologyImaging/Radiology: Uroradiology III1 Apr 2016MP19-06 PREOPERATIVE RADIOLOGIC ASSESSMENT FOR PERINEPHRIC FAT INVASION (T3A): COMPARISON WITH PATHOLOGICAL STAGING Zhamshid Okhunov, Jae Young Park, Chenhui Zhao, Molly Baker, Mohammad Helmy, Chandana Lall, Mari Bozoghlanian, and Jaime Landman Zhamshid OkhunovZhamshid Okhunov More articles by this author , Jae Young ParkJae Young Park More articles by this author , Chenhui ZhaoChenhui Zhao More articles by this author , Molly BakerMolly Baker More articles by this author , Mohammad HelmyMohammad Helmy More articles by this author , Chandana LallChandana Lall More articles by this author , Mari BozoghlanianMari Bozoghlanian More articles by this author , and Jaime LandmanJaime Landman More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.2754AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES We assessed the accuracy of computed tomography (CT) in diagnosing perinephric fat invasion (PNFI) in patients with renal cell carcinoma (RCC). METHODS We retrospectively reviewed preoperative CTs of patients who underwent extirpative surgery for pT1 - pT3a RCC. CT criteria used to assess PNFI were PN soft-tissue stranding (PNSTS), peritumoral vascularity (PTV), increased density of the PNF, tumor margins (TM), and presence of contrast-enhancing soft-tissue nodules in the PN space. PNSTS was defined as linear areas of soft tissue attenuation, corresponding to the bridging septa of the PN space. PTV was defined as asymmetrically enlarged, irregular vessels adjacent to the neoplasm, within the PN space. The CT density of the PNF was measured by placing a circular region of interest, as large as possible within the perirenal space, juxtaposed to the RCC. The CT density of the PNF of the normal contralateral kidney, measured at the area of the lower pole, was used as the standard of reference. A sharply demarcated tumor was characterized as confined within the kidney while ill-defined TM was suggestive of neoplastic invasion of the PNF. The final histopathology was used as the standard of reference. We analyzed the sensitivity and specificity stratified by tumor size (≤4cm, >4 - ≤7cm, >7 - ≤10cm, and >10cm). RESULTS A total of 161 patients were included. Table 1 demonstrates sensitivity and specificity of all assessed variables in predicting PNFI on CT. In logistic regression analysis, PNSTS, increased PTV, ill-defined TM and an enhancing nodule in the perinephric fat were significant predictors of PNFI. In multivariate analysis, PNSTS was the only significant factor for PNFI (table 2). CONCLUSIONS CT imaging does not reliably predict PNFI. However, for tumors >7cm, the absence of PNSTS excludes PNFI. Furthermore, absence of PTV reliably excludes PNFI among tumors from 4 to 10 cm. For tumors < 4cm, a well-defined tumor margin also excludes PNFI. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e205-e206 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Zhamshid Okhunov More articles by this author Jae Young Park More articles by this author Chenhui Zhao More articles by this author Molly Baker More articles by this author Mohammad Helmy More articles by this author Chandana Lall More articles by this author Mari Bozoghlanian More articles by this author Jaime Landman More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Comparison of preoperative adaptive enlargement of the contralateral normal kidney in patients nephrectomized for benign non-functioning kidney versus renal cell carcinoma.

To investigate the potential effects of preoperative volumetric compensation of the contralateral normal kidney on renal function after simple nephrectomy or radical nephrectomy. A total of 306 patients (80 simple nephrectomy patients and 226 radical nephrectomy patients) with 1:3 propensity score matching were included between October 1996 and December 2013. Preoperative three-dimensional kidney volume was estimated from computed tomography images using a specialized volumetric program. Glomerular filtration rate assessed using the Chronic Kidney Disease Epidemiology Collaboration equations was checked preoperatively, 1 week, 3 months and 1 year after nephrectomy. Preoperative mean Chronic Kidney Disease Epidemiology Collaboration glomerular filtration rate was 76.5 mL/min/1.73 m(2) in the simple nephrectomy group and 89.2 mL/min/1.73 m(2) in the radical nephrectomy group. In simple nephrectomy patients, mean Chronic Kidney Disease Epidemiology Collaboration glomerular filtration rate showed a stable pattern up to 3 months (75.5 mL/min/1.73 m(2) at 7 days and 76.2 mL/min/1.73 m(2) at 3 months), and decreased slightly to 72.6 mL/min/1.73 m(2) at 1 year. However, in radical nephrectomy patients, mean Chronic Kidney Disease Epidemiology Collaboration glomerular filtration rate decreased immediately to 63.4 mL/min/1.73 m(2) at 7 days after surgery, and then increased gradually to 64.6 mL/min/1.73 m(2) at 3 months and 65.9 mL/min/1.73 m(2) at 1 year. Preoperative mean contralateral normal kidney volume was 225.7 mL in the simple nephrectomy group and 180.1 mL in the radical nephrectomy group (P < 0.001). The contralateral normal kidney volume to total normal kidney volume ratio was 0.74 in the simple nephrectomy group and 0.51 in the radical nephrectomy group (P < 0.001). Preoperative volumetric compensation of the contralateral normal kidney is important to maintain postoperative renal function in patients undergoing nephrectomy.