Ipsilateral Renal Function Research Articles

Can urinary caspase-3 and cytochrome c levels be used as predictive biomarkers in the management of unilateral antenatal hydronephrosis?

We aimed to investigate the urinary caspase-3 and cytochrome c levels in patients with unilateral antenatal hydronephrosis and to determine whether changes in urinary biomarker levels could be useful for both predicting the need for surgical intervention due to ureteropelvic junction obstruction (UPJO) and postoperative surgical success. Sixty-five children with a history of unilateral antenatal hydronephrosis and postnatal anteroposterior diameter ≥ 10mm were included in this prospective case-control study between January 2013 and December 2021. The obstruction group consisted of 33 patients (28 boys, 84.8%) who underwent open dismembered pyeloplasty due to UPJO. The non-obstructive dilatation (NOD) group consisted of 32 patients (27 boys, 84.4%) with stable or improving hydronephrosis and no significant reduction in ipsilateral split renal function during follow-up, whereas 34 healthy children were enrolled in the study as a control group. Urinary urinary caspase-3 and cytochrome c levels using ELISA were measured. The median preoperative urinary caspase-3 level was significantly higher in the obstruction group when compared to the NOD group (4.82ng/mgCr vs. 2.61ng/mgCr, p = 0.013) as well as the control group (4.82ng/mgCr vs. 1.72ng/mgCr, p = 0.002). In the postoperative period, urinary caspase-3 levels significantly decreased compared to preoperative measurements (4.82ng/mgCr vs. 2.51ng/mgCr, p = 0.006) and became similar to the control group (2.51ng/mgCr vs. 1.72ng/mgCr, p = 0.422). On the other hand, no significant differences were observed in urinary cytochrome c levels between the groups. All patients who underwent pyeloplasty achieved postoperative resolution in hydronephrosis and improved drainage on MAG-3, so none of the patients required re-do pyeloplasty. Postoperative decrease in caspase-3 level was found to be compatible with adequate urine drainage on MAG-3 scan. The cut-off value of urinary caspase-3 to predict patients requiring pyeloplasty was found to be 3.31ng/mg creatinine with 63.6% sensitivity, 62.5% specificity (AUC = 0.679). In the multivariable analysis, urinary caspase-3 level (OR: 1.653, p = 0.019), anteroposterior pelvic diameter (OR: 1.401, p = 0.001), and split renal function on MAG-3 (OR: 1.277, p = 0.011) were found to be independent factors in determining patients who require surgery. Based on our preliminary findings, urinary caspase-3 levels could be a useful biomarker not only for predicting the need for surgical intervention but also for determining the postoperative surgical success in children with UPJO.

Relation factor analysis for the short-term preservation of ipsilateral renal function after partial nephrectomy

Objectives: To analyze the factors relative to the short-term preservation of ipsilateral renal function after partial nephrectomy. Methods: The clinical data of 83 patients who were treated with partial nephrectomy from December 2014 to December 2019 in the Department of Urology, Sun Yat-sen University Cancer Center were retrospectively analyzed. There were 54 males and 29 females, aging (M (IQR)) 49 (17) years (range: 27 to 74 years). The ischemia time in operation was 25 (18) minutes (range: 10 to 67 minutes). Emission computed tomography scan and CT scan were performed before (within 1 month) and after (3 to 12 months) surgery. The volume of the ipsilateral and contralateral kidney was measured on the basis of preoperative and postoperative CT scans. The glomerular filtration rate (GFR) specifically in each kidney was estimated by emission computed tomography. Recovery from ischemia is determined by the formula: GFR preservation/volume saved×100%. Linear regression was used to explore the factors ralative to the short-term preservation of ipsilateral renal function after partial nephrectomy. Results: The GFR preservation of the ipsilateral kidney was 80.9 (25.2) % (range: 31.0% to 109.4%). The volume loss of the kidney resulted in a decrease of 12.0% (5.8 ml/(min×1.96 m2)) of GFR, while the ischemic injury resulted in a decrease of 6.5% (2.5 ml/(min×1.96 m2)) of GFR. The volume saved from the ipsilateral kidney was 87.1 (12.9) % (range: 27.0% to 131.7%). Recovery from ischemia was 93.5 (17.5) % (range:44.3% to 178.3%). In multivariate analysis, GFR preservation of the ipsilateral kidney was significantly correlated with the volume saved of the ipsilateral kidney (β=0.383, 95%CI: 0.144 to 0.622, P=0.002). It was not related to the ischemia time (β=0.046, 95%CI:-0.383 to 0.475, P=0.831). Conclusion: In the condition of limited ischemic time, in the short term ipsilateral renal function after partial nephrectomy is mainly determined by the loss of kidney volume, while ischemic injury only plays a minor role.

Longitudinal changes in renal parenchymal volume and function status after partial nephrectomy: a retrospective cohort study.

The ipsilateral renal parenchymal volume (RPV) experiences a sharp decrease shortly after partial nephrectomy (PN), mainly due to surgical remove or devascularization of kidney tissue. However, the subsequent change of RPV and its association with glomerular filtration rate (GFR) fast decline remains unknown. Our objective was to investigate the change of ipsilateral RPV and renal function status from new baseline (1-12 months after PN) to latest follow-up (≥1 year) after PN, and to explore factors associated with ipsilateral RPV decrease rate and correlation between RPV decrease and GFR fast decline. A retrospective review of 367 patients with PN was conducted. Three-dimensional reconstruction of computed tomography (CT)/MRI images was performed for RPV calculation. Spectrum score was used to assess the degree of acute kidney injury (AKI) in the operated kidney after PN. GFR decline greater than 3ml/min/1.73m 2 /year was defined as GFR fast decline. One hundred fourteen patients underwent abdominal surgery was used as control. Predictive factors for subsequent decrease of RPV rate and GFR fast decline were evaluated by linear and logistic regression, respectively. With a median interval time of 21.1 (interquartile range:13.8-35.5) months, median ipsilateral RPV significantly decreased from 118.7 (interquartile range:100.7-137.1) ml at new baseline to 111.8 (IQR: 92.3-131.3) ml at latest follow-up. The interval time [β: 1.36(0.71-2.01), P <0.001] and spectrum score [β: 5.83 (2.92-8.74), P <0.001] were identified as independent predictors of ipsilateral RPV decrease rate. GFR fast decline was observed in 101 (27.5%) patients. Annual ipsilateral RPV decrease rate [odds ratio:1.67 (1.05-2.67), P =0.03] and overweight [odds ratio:1.63 (1.02-2.60), P =0.04] were independent predictors of GFR fast decline. Ipsilateral RPV experienced a moderate but significant decrease during follow-up after PN, especially in those with severer acute kidney injury. The presence of GFR fast decline was found to be associated with reduction of ipsilateral RPV, particularly in overweight individuals.

Supranormal differential renal function on MAG3 scan in children with ureteropelvic junction obstruction – Prevalence and pyeloplasty during follow-up

Children with suspected ureteropelvic junction obstruction (UPJO) may present with a paradoxical ipsilateral supranormal differential renal function (snDRF) on 99mTechnetium mercaptoacetyltriglycine scintigraphy (MAG3 scan). The aim was to investigate the prevalence of snDRF, the risk of pyeloplasty among children with UPJO and snDRF, and to explore the experience of snDRF among international pediatric urologists. A retrospective cohort study of children with suspected unilateral UPJO who underwent MAG3 scan at four hospitals in Sweden between 2005 and 2020. SnDRF was defined as DRF ≥55%. Normal DRF was defined as DRF 45-54%. Primary outcome was risk of pyeloplasty. Indications for pyeloplasty were loss of >10%-points of differential renal function (DRF), ipsilateral DRF <40%, or symptomatic UPJO. Logistic and cox regressions were performed in univariate and multivariable analyses, adjusting for age, gender, year, laterality, antenatal hydronephrosis, anterior-posterior diameter (APD), and kidney size. An international questionnaire regarding the management of snDRF was developed and distributed to pediatric urologists. The prevalence of snDRF was 19%. SnDRF was more common in boys, children with antenatal hydronephrosis, children undergoing their first MAG3 scan at a younger age, and in the left kidney. After further exclusion of 70 children with DRF <45%, a total of 264 were included for longitudinal follow-up of median 6.6 (IQR 2.5-11.5) years. SnDRF was not associated with increased risk of pyeloplasty (adjusted OR 0.98 (95% CI 0.41-2.33), p=0.96, and adjusted HR 1.00 (95% CI 0.53-1.91), p=0.99) or time to pyeloplasty (1.1 years vs. 1.6 years, p=0.40). Among the 79 surveyed pediatric urologists, a majority would not change clinical UPJO-management based on the presence or absence of ipsilateral snDRF. There are only a few studies considering the need of pyeloplasty based on the presence of snDRF and this is the first survey among pediatric urologists on its management. With more included patients than previous studies, this study showed a snDRF prevalence of 19%, congruent with the findings of others. The underlying cause of snDRF is debated, but it cannot solely be explained as an artifact of hydronephrotic kidneys. Further studies on the clinical implications of snDRF are warranted, since DRF influences the decision to operate. A fifth of all children with suspected UPJO presented with ipsilateral snDRF on initial MAG3 scan, and snDRF was not associated with a greater risk of pyeloplasty. Supported by a large group of international pediatric urology colleagues, this study concludes that the same clinical follow-up and management apply, regardless of presence of snDRF.

PD45-02 THE IDEAL TIME INTERVAL BETWEEN REPEATED SHOCK WAVES LITHOTRIPSY SESSIONS FOR RENAL STONES: A RANDOMIZED CONTROLLED TRIAL

You have accessJournal of UrologyCME1 Apr 2023PD45-02 THE IDEAL TIME INTERVAL BETWEEN REPEATED SHOCK WAVES LITHOTRIPSY SESSIONS FOR RENAL STONES: A RANDOMIZED CONTROLLED TRIAL Mohamed Fadallah, Ahmed R. EL-Nahas, Ahmed Abdelhalim, Wael I. Mortada, Abdelwahab Hashem, Hadeer A.M. Ibrahim, Khaled Z. Sheir, and Mahmoud R. EL-Kenawy Mohamed FadallahMohamed Fadallah More articles by this author , Ahmed R. EL-NahasAhmed R. EL-Nahas More articles by this author , Ahmed AbdelhalimAhmed Abdelhalim More articles by this author , Wael I. MortadaWael I. Mortada More articles by this author , Abdelwahab HashemAbdelwahab Hashem More articles by this author , Hadeer A.M. IbrahimHadeer A.M. Ibrahim More articles by this author , Khaled Z. SheirKhaled Z. Sheir More articles by this author , and Mahmoud R. EL-KenawyMahmoud R. EL-Kenawy More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003358.02AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: There is no consensus about the optimal time intervals between SWL repeated sessions. The study was conducted to assess the ideal interval between repeated SWL for renal stones. METHODS: The study protocol was approved by local ethical committee (ID: MD.20.05.327) and was registered to clinicaltrial.gov (NCT04575480). A randomized controlled trial was conducted between July 2020 and March 2022. Eligible patients with single renal stone<2 cm who required multiple SWL sessions were randomly assigned to one of three groups. Patients underwent 2nd session after (3,7 and 14 days) for groups (1,2 and 3) respectively. Tubular damage was assessed through estimation of changes in urinary execration of KIM-1, N-GAL and IL-18. While glomerular damage was assessed by the protein/ creatinine ratio and changes in renal DTPA isotope scan. Treatment success were assessed by NCCT after 3 months. RESULTS: The study included 166 patients. All patient's demographics were comparable between groups. There was significant elevation of protein /creatinine ratio and all tubular biomarkers post 1st and 2nd SWL when compared with pre-SWL values (p<0.0001 in all). All tubular damage biomarkers' values returned to pre-SWL at the planned day for the 3rd session in group 2 and 3 only (table 1). At 3 month follow up all urinary biomarkers and protein /creatine ratio were less than pre-SWL values in all groups. However, a significant decrease in ipsilateral renal split function was observed in group 1 only (p. value=0.005,0.887 and0.337 for group 1, 2 and 3 respectively . SWL treatment succeeded in 73.6% in group 1, 83.7% in group 2 and 81% in group 3. CONCLUSIONS: At least 7 days' interval is required between repeated session for treatment of renal stones to allow for complete recoverability of kidney glomerular and tubular functions. Source of Funding: we received funding from Urology and Nephrology Center - Mansoura University, Egypt © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e1162 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Mohamed Fadallah More articles by this author Ahmed R. EL-Nahas More articles by this author Ahmed Abdelhalim More articles by this author Wael I. Mortada More articles by this author Abdelwahab Hashem More articles by this author Hadeer A.M. Ibrahim More articles by this author Khaled Z. Sheir More articles by this author Mahmoud R. EL-Kenawy More articles by this author Expand All Advertisement PDF downloadLoading ...

Stability of renal parenchymal volume and function during active surveillance of renal oncocytoma patients.

To evaluate whether significant loss in ipsilateral renal parenchymal volume (IRPV) and renal function occurs during active surveillance (AS) of renal oncocytoma (RO) patients. Renal function (estimated glomerular filtration rate, eGFR) dynamics were retrospectively analyzed in 32 consecutive biopsy-diagnosed RO patients managed with AS at a National Comprehensive Cancer Network institute. Three-dimensional kidney and tumor reconstructions were generated and IRPV was calculated using volumetry software (Myrian®) for all patients with manually estimated RO growth >+10 cm3. GFR and IRPV were compared at AS initiation vs. the last follow-up using 2-sided paired t-tests. The correlation between change in IRPV and change in RO size or GFR was tested using a Spearman coefficient. With median follow-up of 37 months, there was no significant change between initial vs. last eGFR (median 71.0 vs. 70.5 ml/min/1.73 m2, P = 0.50; median change -3.0 ml/min/1.73 m2). Among patients (n = 17) with RO growth >+10 cm3 during AS (median growth +28.6 cm3, IQR +16.9- + 46.5 cm3), IRPV generally remained stable (median change +0.5%, IQR -1.2%- + 1.2%), with only 2 cases surpassing 5% loss. No IRPV loss was detected among any patient within the top tertile of RO growth magnitude. RO growth magnitude did not correlate with loss of either IRPV (ρ = -0.30, P = 0.24) or eGFR (ρ = -0.16, P = 0.40), including among patient subsets with lower initial eGFR. Study limitations include a lack of long-term follow-up. Volumetry is a promising novel tool to measure kidney and tumor tissue changes during AS. Our study using volumetry indicates that clinically significant loss of IRPV or eGFR is uncommon and unrelated to tumor growth among untreated RO patients with intermediate follow-up. These findings support that AS is in general functionally safe for RO patients, however longer study is needed to determine safety durability, particularly among uncommon ≥cT2 RO variants.

Percutaneous management of ureteropelvic junction obstruction.

The development of endoscopic and minimally invasive techniques has revolutionized the treatment of ureteropelvic junction obstruction (UPJO). Patients can now undergo successful UPJO repair without the morbidity and complications associated with open surgery. Laparoscopic and robotic repair has supplanted open surgery as the gold standard, but percutaneous endoscopic treatment remains a relevant alternative to more invasive surgery. This review will focus on the percutaneous approach for the treatment of UPJO. Percutaneous endopyelotomy was popularized during the 1980 s due to advances in the field of endourology, allowing for well tolerated and reliable percutaneous access to the kidney. After percutaneous access to the kidney is achieved, the narrowed ureter at the UPJ is incised in a full thickness fashion in the posterolateral position from the ureteral lumen to the periureteral fat. Success rates for this procedure are nearly 90% at high-volume centres. The ideal patient who has success with percutaneous endopyelotomy has a short segment of narrowing less than 2 cm, no crossing vessel, good ipsilateral renal function and mild hydronephrosis. Although the development of laparoscopic and robotic approaches to pyeloplasty has produced outcomes that surpass those of percutaneous endopyelotomy, it remains a viable option in the appropriately selected patient, but success rates tend to decrease with longer follow up.

Association between decreased ipsilateral renal function and aggressive behavior in renal cell carcinoma

BackgroundTo assess prognostic value of pre-operative ipsilateral split renal function (SRF) on disease-free survival (DFS) and its association with aggressive pathological features in renal cell carcinoma (RCC) patients. MethodsWe examined patients registered in SNUG-RCC-Nx who underwent partial or radical nephrectomy at Seoul National University Hospital between January 1, 2010 and December 31, 2020. Patients with the following criteria were excluded from the study. 1) non-kidney origin cancer or benign renal tumor, 2) no pre-operative Tc 99 m-DTPA renal scan, 3) single kidney status or previous partial or radical nephrectomy, and 4) bilateral renal mass. Finally, 1,078 patients were included.ResultsAmong 1,078 patients, 899 (83.4%) showed maintained ipsilateral SRF on DTPA renal scan; 179 patients (16.6%) showed decreased SRF. The decreased SRF group showed significantly large tumor size (maintained vs. decreased SRF; 3.31 ± 2.15 vs. 6.85 ± 3.25, p < 0.001), high Fuhrman grade (grade 3–4) (41.7% vs. 55.6%, p < 0.001), and high T stage (T stage 3–4) (9.0% vs. 20.1%, p < 0.001). Pathological invasive features, including invasion of the renal capsule, perirenal fat, renal sinus fat, vein, and collecting duct system, were associated with low SRF of the ipsilateral kidney. Univariate Cox regression analysis identified higher SSIGN (The stage, size, grade, and necrosis) score and decreased ipsilateral SRF as significant risk factors, while multivariate analysis showed SSIGN (5–7) (hazard ratio [HR] 11.9, p < 0.001) and SSIGN (8–10) (HR 69.2, p < 0.001) were significantly associated with shortened DFS, while decreased ipsilateral SRF (HR 1.75, p = 0.065) showed borderline significance. Kaplan–Meier analysis showed that decreased ipsilateral SRF (< 45%) group had shorter DFS than the other group (median DFS: 90.3 months vs. not reached, p < 0.001).ConclusionsAmong unilateral RCC patients, those with low ipsilateral SRF showed poor prognosis with pathologically invasive features. Our novel approach may facilitate risk stratification in RCC patients, helping formulate a treatment strategy.

Stereotactic Body Radiotherapy for Renal Cell Carcinoma: Oncological and Renal Function Outcomes

AimsTo evaluate oncological and renal function outcomes of stereotactic body radiotherapy (SBRT) for medically inoperable patients with localised renal cell carcinoma. Materials and methodsConsecutive patients treated with curative intent SBRT (30–45 Gy in five fractions or 42 Gy in three fractions) were included. Data on local control (Response Evaluation Criteria in Solid Tumors [RECIST] v1.1), distant metastasis, impact on estimated glomerular filtration rate (eGFR) and proportional ipsilateral and contralateral renal functions (measured through renal scans) were collected. Univariate and multivariable analyses were conducted to determine association of variables with oncological and renal function outcomes. ResultsSeventy-four patients were analysed. The median follow-up was 27.8 months (interquartile range 17.6–41.7). Fifty-seven per cent had tumours ≥ T1b. One-, 2- and 4-year cumulative incidence of local failure was 5.85, 7.77 and 7.77%, respectively. The cumulative incidence of distant metastasis at 2 years was 4.24%. On multivariable analysis, a lower planning target volume (PTV) mean dose (P = 0.019) and a larger PTV (P = 0.005) were significantly associated with the risk of developing local failure. A lower PTV maximum dose (P = 0.039) was significantly associated with the risk of developing distant metastasis. The median change in global eGFR (ml/min) from pre-SBRT levels was –7.0 (interquartile range –14.5 to –1.0) at 1 year and –11.5 (interquartile range –19.5 to –4.0) at 2 years. The proportion of ipsilateral (differential) renal function decreased over time from 47% of overall renal function pre-SBRT to 36% at 2 years, whereas the proportion of contralateral renal function correspondingly improved. On multivariable analysis, a higher volume of uninvolved renal cortex (P < 0.0001) was significantly associated with a smaller decrease in eGFR over time. ConclusionIn this large institutional cohort, oncological outcomes of renal cell carcinoma treated with SBRT were favourable and a longitudinal decline in renal function in the ipsilateral kidney and compensatory increase in the contralateral kidney were observed. Clinical and dosimetric factors were significantly associated with oncological and renal function outcomes.

Development of a novel predictive model for a successful stone removal after flexible ureteroscopic lithotripsy based on ipsilateral renal function: a single-centre, retrospective cohort study in China.

ObjectivesThe aims of this study were to investigate the effect of preoperative ipsilateral renal function on the success of kidney stone removal with flexible ureteroscopic lithotripsy and to develop a predictive model based on the results.DesignRetrospective cohort study.SettingData from the 2001–2012 period were collected from the electronic records of West China Hospital, Sichuan University.Participants576 patients who underwent flexible ureteroscopic lithotripsy were included in the study.Primary outcomeStone-free rate (SFR) after the procedures.ResultsIn patients with suspected impaired kidney function, the overall SFR was 70.1%. Stone volume (OR 1.46; 95% CI 1.18 to 1.80), lower calyx stones (OR 1.80; 95% CI 1.22 to 2.65), age (OR 1.02; 95% CI 1.00 to 1.04), body mass index (OR 1.10; 95% CI 1.04 to 1.17) and estimated glomerular filtration rate of the affected kidney (OR 0.95; 95% CI 0.94 to 0.97) were identified as independent predictors of SFR. Lasso regression selected the same five predictors as those identified by univariate and multivariate logistic regression analyses, thus verifying our model. The mean area under the curve, based on 1000 iterations and 10-fold validation, was 0.715 (95% CI 0.714 to 0.716). The Hodges-Lehmann test and calibration curve analysis revealed no significant mismatch between the prediction model and the retrospective cohort.ConclusionIpsilateral renal function may be a novel independent risk factor for kidney stone removal with flexible ureteroscopic lithotripsy. A novel nomogram for predicting SFR that uses stone volume, lower calyx stones, age, body mass index and estimated glomerular filtration rate was developed, but remains to be externally validated.

Is off-clamp robot-assisted partial nephrectomy beneficial for renal function? Data from the CLOCK trial.

To compare the functional outcomes of on- vs off-clamp robot-assisted partial nephrectomy (RAPN) within a randomized controlled trial (RCT). The CLOCK study (CLamp vs Off Clamp the Kidney during robotic partial nephrectomy; NCT02287987) is a multicentre RCT including patients with normal baseline function, two kidneys and masses with RENAL scores ≤ 10. Pre- and postoperative renal scintigraphy was prescribed. Renal defatting and hilum isolation were required in both study arms; in the on-clamp arm, ischaemia was imposed until the completion of medullary renorraphy, while in the off-clamp condition it was not allowed throughout the procedure. The primary endpoint was 6-month absolute variation in estimated glomerular filtration rate (AV-GFR); secondary endpoints were: 12, 18 and 24-month AV-GFR; 6-month estimated glomerular filtration rate variation >25% rate (RV-GFR >25); and absolute variation in ipsilateral split renal function (AV-SRF). The planned sample size was 102 + 102 cases, after taking account crossover of cases to the alternate study arm; a 1:1 randomization was performed. AV-GFR and AV-SRF were compared using analysis of covariation, and RV-GFR >25 was assessed using multivariable logistic regression. Intention-to-treat (ITT) and per-protocol analyses (PP) were performed. A total of 160 and 164 patients were randomly assigned to on- and off-clamp RAPN, respectively; crossover was observed in 14% and 43% of the on- and off-clamp arms, respectively. We were unable to find any statistically significant difference between on- vs off-clamp with regard to the primary endpoint (ITT: 6-month AV-GFR -6.2 vs -5.1 mL/min, mean difference 0.2 mL/min, 95% confidence interval [CI] -3.1 to 3.4 [P = 0.8]; PP: 6-month AV-GFR -6.8 vs -4.2 mL/min, mean difference 1.6 mL/min, 95% CI -2.3 to 5.5 [P = 0.7]) or with regard to the secondary endpoints. The median warm ischaemia time was 14 vs 15 min in the ITT analysis and 14 vs 0 min in the PP analysis. In patients with regular baseline function and two kidneys, we found no evidence of differences in functional outcomes for on- vs off-clamp RAPN.

Management of long ureteral stenosis: Alternatives to indwelling ureteral stents

Evaluate kidney autotransplantation (KAT) and ileal ureter substitution (IUS) practice and outcome as alternatives to indwelling ureteral stents for the management of long ureteral stenosis (US). We included all patients treated for US with KAT or IUS in 5 French university urology centers between 2010 and 2018. We excluded US due to urothelial carcinoma. Primary endpoint was the preservation of ipsilateral kidney and renal function without any urinary diversion. 22 patients were treated with KAT (n=8, 36.4%) and IUS (n=14, 63.6%). Mean US length was 4.6cm and 6cm (P=0.52) in KAT and IUS groups respectively. US etiologies were lithiasis, iatrogenic, retroperitoneal fibrosis or extrinsic compression. US level was varied. The surgery was described as difficult because of peritoneal adhesions or major peri-ureteral fibrosis. Mean operating time and hospital stay were 336 and 346minutes (P=0.87) and 8 and 15 days respectively (P=0.001). Postoperative complications were mostly Clavien ≤2 (n=17, 77.3%). Revision surgery was required in the KAT group in 3 cases (37.5%), for textiles, renal vein thrombosis and anastomotic leak, none in the IUS group. The mean follow-up was 15.7 months. All but one (in the KAT group) ipsilateral kidneys were preserved, without renal function impairment (Δcreat +2.1 vs. +2.4μmol/l respectively, P=0.67), nor urinary diversion. KAT and IUS are safe alternatives whose indication depends on surgeons expertise. Our study pointed out the scarcity of this practice suggesting the need to refer patients to expert centers. 3.

Differential contribution of the factors determining long-term renal function after partial nephrectomy over time

PurposeTo define how much of renal function was determined by the preserved renal parenchymal volume and the ischemic insult during partial nephrectomy (PN) long after surgery. MethodsWe analyzed the data of 530 consecutive patients who had undergone PN. For all patients, renal function was measured preoperatively and again at 3 postoperative months, then annually using 99mTc-diethylenetriaminepentaacetic acid renal scan. Perioperative variables potentially affecting the long-term ipsilateral glomerular filtration rate (GFR) and their time-varying contribution were assessed using a linear mixed model. ResultsThe mean preoperative ipsilateral GFR was 42.9 ml/min, which decreased by 27.3% at 3 months but began to recover thereafter continuing until 4 years (Δ% GFR at 1, 2, 3, 4, and 5 years: 22.3%, 18.5%, 14.7%, 10.0%, and 9.6%, respectively). Parenchymal volume reduction and ischemic time were significantly associated with postoperative ipsilateral GFR throughout observation period unvarying with time. Diabetes and proteinuria were not significant determinants of ipsilateral function at 3 months but became significant at 5 years. In multivariate analysis regarding recovery slope, volume reduction (β = −0.026, SE 0.006, P < 0.0001), preoperative ipsilateral GFR (β = −0.021, SE 0.007, P = 0.0012), proteinuria (β = −0.942, SE 0.372, P = 0.0116), and diabetes (β = −0.396, SE 0.197, P = 0.0447) were independently significant. ConclusionIpsilateral renal function continued to improve until 5 years after PN. Parenchymal volume loss was the major determinant and its impact on long-term ipsilateral renal function remained constant while ischemic time affected early GFR reduction with its impact diminishing over time. Patient-related factors including diabetes and proteinuria gained significance over time and became independent determinants of recovery slope.

Outcome of Open Pyeloplasty on Ipsilateral Renal Function

Objective: The objective of this study is to determine the ipsilateral renal function after open pyeloplasty. Patients and methods: The study comprises 50 patients with ultrasonographically and urographically demonstrated hydronephrosis and primary pelvi-ureteric junction obstruction for reconstructive surgical treatment at urology department of Bangabandhu Sheikh Mujib Medical University Hospital between January 2012 and September 2013. Anderson- Hynes pyeloplasties were performed in 50 patients. Data were collected by interview, review of records and documents in data collection sheet. Data were analyzed by using paired t-test. Level of significance was set at 5%(P&lt;0.05). Statistical analysis done by SPSS (SPSS Inc. Chicago, IL, USA), version 16.0.0. Results: The male and female ratio was1: 0.33. Mean age of the patients was 7.35 years. Left and right side ratio was 1.5: 1. The mean ± SD of pre operative cortical thickness was 3.67 ± 0.91 and post operative thickness after 1 month, 3 months, 6 months and 12 months were 3.95 ± 0.91, 4.61 ± 1.18, 4.61 ± 1.18, 5.15 ± 1.31 and 6.22 ± 1.37 respectively. The mean ± SD of split renal function were 24.22 ± 3.42 and 29.14 ± 4.20 in pre operative and post operative respectively. The mean ± SD of split GFR were 25.38 ± 4.11and 34.47 ± 6.30 in pre operative and post operative respectively. Renal functional status was seen as improvement in 39, stable in 3, and deterioration in 2 patients. Conclusions: When dealing with patients with pelviureteric junction obstruction, surgical treatment should be undertaken in patients with symptoms and/or impaired renal function. Bangladesh Journal of Urology, Vol. 18, No. 1, Jan 2015 p.28-32

Moderate and severe fetal pyelectasis: Correlation between prenatal aspects and postnatal outcome.

Renal pelvic dilatation (RPD) is a frequent finding in fetal ultrasound. The aim of the study is to correlate the prenatally detected moderate and severe pyelectasis with the postnatal outcome. A retrospective analysis involving 90 cases of prenatally detected moderate and severe RPD referred to our prenatal diagnosis centre with 18 months of urological follow-up. Prenatal ultrasound was correlated with postnatal renal function, assessed by plasmatic creatinine and/or renal scintigraphy performed before surgery. Cases were divided between two groups according to postnatal management: group A including 35 newborns (38.9%) that needed surgical treatment and group B with 55 patients (61.1%) who were managed conservatively. The group A presented higher median RPD (18 mm, IQR 12-25 mm) compared to the group B (11 mm, IQR 10-14 mm). The most common anomaly detected within group A was pelvi-ureteric junction (PUI) obstruction (43%). Within group B 32 cases (58%) showed spontaneous resolution of hydronephrosis during postnatal follow up. In case of moderate pyelectasis the risk of postnatal surgery was 25% and raised to 60% for severe RPD. In our study, 29 newborns showed pathologic scintigraphies: 25 required surgery while 4 did not find indication for surgery due to ipsilateral renal function irreversible damage. 6 patients had high creatinine level (>0.6 mg/dl). 35 cases out of 90 (39%) developed monolateral irreversible renal function impairment. Moderate and severe RPD are often correlated with postnatal renal damage, therefore a close multidisciplinary follow-up is required. Prenatal scanning is highly predictive of postnatal outcome and can address properly the prenatal counseling.

Comparative Study Assessing Postoperative Renal Loss Using Two Different Partial Nephrectomy Techniques: Off-Clamp versus Standard On-Clamp Surgery

Objectives: To evaluate a case-matched study comparing postoperative renal function using two surgical techniques: an off-clamp partial nephrectomy (PN) with the aid of the Altrus® device and a standard on-clamp laparoscopic PN. Material and Methods: A total of 36 patients underwent PN. Eighteen had the off-clamp technique and 18 had the standard laparoscopic on-clamp PN. Demographic, clinical, radiological, and perioperative data were collected for analysis. An emphasis on renal function was made by analyzing both the perioperative and follow-up with estimated glomerular filtration rate and MAG3. Results: The median values did not signifcantly differ for age, Charlson Comorbidity Index, and hospital stay in the off-clamp versus on-clamp PN [62.5 (interquartile range, IQR 11) vs. 60 (IQR 16) years, 4 (IQR 2) vs. 5 (IQR 2) and 5 (IQR 1) vs. 4 (IQR 2) days], respectively. The median diameter of the tumors was 33 (IQR 23) versus 41 (IQR 28) mm (p = 0.63), with median R.E.N.A.L. nephrometry scores of 7 (IQR 2) versus 7 (IQR 2) (p = 0.33). There was greater blood loss in the Altrus® (375 vs. 200 ml, p = 0.037). The clamp time in the on-clamp group was 30 (IQR 6) minutes (range 22-68 minutes) compared to 0 minutes in the off-clamp group. There was no difference in hemoglobin or creatinine levels between the groups. However, the on-clamp group had a significant loss in ipsilateral renal function on the MAG3 scan (49 vs. 42%, p = 0.0001), whereas the off-clamp group had no difference (48 vs. 46%, p = 0.72). Conclusions: The off-clamp method for PN is a feasible and safe option with better preservation of ipsilateral renal function when compared with on-clamp PN in the treatment of small renal masses.

The role of RENAL, PADUA, C-index, CSA nephrometry systems in predicting ipsilateral renal function after partial nephrectomy

BackgroundFunctional outcome is an important issue in nephron-sparing surgery. Various nephrometries have been developed to predict renal function preservation. The aim of this study was to examine the applicability of R.E.N.A.L., PADUA, C-index, and mathematical tumor contact surface area (CSA) in predicting ipsilateral renal function after partial nephrectomy using radio-isotope scans.MethodsWe performed this retrospective study in patients who underwent partial nephrectomy between May 2013 and April 2017, and used abdominopelvic computerized tomography or magnetic resonance imaging to obtain R.E.N.A.L., C-index, and CSA. Renal function was measured by 99mTc mercaptoacetyltriglycine (MAG3). We evaluated correlations between nephrometries and perioperative parameters, and comparatively analyzed different nephrometries to determine the predictive ability in the percent change of effective renal plasma flow of the affected kidney.ResultsThree, two, and 35 patients received partial nephrectomy in open, laparoscopic, and robotic approaches, respectively. The median (IQR) tumor size was 3.13 (2.4) cm. The median (IQR) R.E.N.A.L., PADUA, C-index, and CSA scores were 7 (3), 8 (2), 2.01 (1.87), and 14.14 (19.25) cm2, respectively. Spearman correlation analysis showed that four nephrometries were correlated with each other. The strongest correlations were between CSA and C-index (coefficient: − 0.885, p < 0.001), followed by R.E.N.A.L. and PADUA (coefficient: 0.778, p < 0.001). Ischemia time was significantly correlated with R.EN.A.L. (coefficient: 0.35, p = 0.025), PADUA (coefficient: 0.42, p = 0.007), C-index (coefficient: − 0.45, p = 0.004), and CSA (coefficient: 0.41, p = 0.009). In multivariate analysis, PADUA significantly affected ischemia time (p = 0.04). The percent change in effective renal plasma flow (PCE) of the operated kidney was correlated with PADUA (coefficient: 0.48 p = 0.002), C-index (coefficient: − 0.74, p < 0.001), and CSA (coefficient: 0.75, p < 0.001). Only CSA and C-index independently affected PCE (both p < 0.05) in multivariate analysis. In ROC curve analysis, both C-index and CSA could predict 20% change in effective renal plasma flow (AUC: 0.91 vs 0.86, p = 0.2) of the affected kidney.ConclusionsWe suggest using PADUA to evaluate surgical complexity and ischemia time. Regarding the accuracy of the prediction of post-operative ipsilateral renal function, both CSA and C-index outperformed R.E.N.A.L. and PADUA nephrometries.

Management of ureteropelvic junction obstruction associated with congenital upper urinary tract anomalies in children: Single-center experience

Purpose We report our experience in the management of ureteropelvic junction obstruction in children with congenital upper urinary tract anomalies.Materials and methods A retrospective review was performed for all children with primary ureteropelvic junction obstruction associated with upper urinary tract anomalies between 1999 and 2011 at our hospital. Medical records were reviewed for patient age, sex, type of urinary tract anomalies, affected side, indication of surgery, and operative details. Clinical and radiological outcomes were assessed. Success was defined as both symptomatic relief and radiographic resolution of obstruction at final follow-up.Results There were 12 children (10 boys and two girls) with mean age of 5.3 years (range 1–13 years). Anomalies included ectopic pelvic kidney in six patients, crossed fused ectopia in two, a horseshoe kidney in two, and duplex renal units in two. The left kidney was affected in seven and the right kidney in five children. All patients were managed by open dismembered pyeloplasty. No significant perioperative complications were encountered in the study group. The mean follow-up was 30 months (range 15–45 months). Overall success rate was 84%. Relief of obstruction was evident in 10 patients as documented by intravenous urography or diuretic renography. Secondary nephrectomy was necessitated in two patients; one had severely impaired ipsilateral renal function and the other had recurrent pyelonephritis without radiological improvement.Conclusion Despite the anomalous renal anatomy and the challenging surgical exposure, dismembered pyeloplasty in children with upper urinary tract anomalies has a high success rate with excellent functional results.Keywords: crossed ectopic, horseshoe kidney, obstruction, pyeloplasty, ureter

The significance of predictable traumatic area by renorrhaphy in the prediction of postoperative ipsilateral renal function

The significance of predictable traumatic area by renorrhaphy in the prediction of postoperative ipsilateral renal function

Assessing Time of Full Renal Recovery Following Minimally Invasive Partial Nephrectomy

To assess renal function in the operated kidney at different time points post partial nephrectomy (PN) and establish the time in which optimal recovery occurs. Recovery of renal function post-PN has received significant attention. However, the optimal time to determine full recovery has not been clearly established. Renal function following minimally invasive (laparoscopic and robotic) PNs performed between 2002 and 2015 was reviewed. Patients included in this study had renal function assessed preoperatively as well as 3 days, 6-12 weeks, and 1 year post-PN, using a combination of estimated glomerular filtration rate (eGFR) from serum creatinine and relative renal uptake (RRU) from Tc99m-MAG3 renal scintigraphy. Together, eGFR and RRU provide the ipsilateral renal function (IRF) of the operated organ. At 6-12 weeks postoperatively, percent preserved eGFR, RRU, and IRF (relative to preoperative baselines) were 92.1%, 83.3%, and 77.4% respectively. %IRF at 6-12 weeks was significantly improved from %IRF at 3 days postoperatively, but did not differ significantly from 1 year postoperatively. Furthermore, 89% of patients had RRU values at 6-12 weeks which differed by less than 5% from RRU values at 1 year. Our data suggest that renal function recovery at 6-12 weeks was equivalent to long-term recovery at 1 year in the majority of post-PN patients. This has important implications for post-PN follow-up, particularly in assessing the functional outcomes utilizing novel minimally invasive PN strategies, as well as in planning staged procedures for bilateral synchronous renal masses.