Nephrectomy For Nonfunctioning Kidney Research Articles

Total clipless laparoscopic nephrectomy carried out with the LigaSure device: Preliminary experience.

Total laparoscopic nephrectomy has become the standard method for the removal of diseased kidneys. The purpose of this study was to evaluate the feasibility of the LigaSure vessel closure system during laparoscopic nephrectomy. From January 2018 to June 2018, the LigaSure device was used in 5 patients undergoing laparoscopic nephrectomy for non functional kidney. Nephrectomy was carried out without the use of clips or sutures for vessel closure. We report intraoperative findings, conversion rates, blood loss, operative time, morbidity, and postoperative outcomes. Median operative time was 45minutes (range 25 to 60min). Median blood loss was 30mL (range 10 to 50mL). No conversions to open surgery were necessary. No patients experienced major bleeding intraoperatively or postoperatively. All patients left the hospital one day after the procedure. Histopathological examination of the removed kidneys was in favor of chronic non specific pyelonephritis. For the treatment of the renal pedicle during total laparoscopic nephrectomy of a destroyed kidney, the LigaSure device appears to be feasible and effective. Our experience is the first to demonstrate the advantages of LigaSure® in laparoscopic nephrectomy: reduction in operating time, blood loss, transfusions and length of stay in hospital.

Role of routine nephrectomy for non-functioning kidneys due to genitourinary tuberculosis: Data from an Indian subcontinent

Objective: To evaluate the role of routine nephrectomy for tuberculous non-functioning kidney (TNFK) after receiving anti-tubercular therapy (ATT) by demonstrating whether live tubercle bacilli persist in nephrectomy specimens after treatment or not. Materials and methods: Patients with TNFK who underwent nephrectomy after completion of at least 6 months of ATT were included in this prospective cohort study. We sent tissue/pus from a nephrectomy specimen for acid-fast bacilli (AFB) staining, polymerase chain reaction (PCR) and culture to look for live bacilli. Bacilli were considered alive only if AFB culture was positive. Results: Twenty-four patients underwent nephrectomy for TNFK between April 2015 and October 2017 (18 laparoscopic and 6 open nephrectomy). Laparoscopic nephrectomy was associated with lower blood loss (225 ml versus 408 ml, p = 0.0003) and shorter hospital stay (3 versus 3.8 days, p = 0.06) compared with open nephrectomy; however, mean operative time and overall complications were similar. Eight specimens were AFB smear and/or tuberculosis PCR positive, out of which three showed viable bacilli upon culture. Drug sensitivity testing showed multi-drug resistant strain in all three patients who were treated with second-line ATT. Conclusion: It is preferable to do routine nephrectomy for TNFKs as they are more likely to harbour live bacilli and lead to disease recurrence. Viability testing for AFB must be performed on all operated specimens to identify drug resistant bacilli so that patients may be treated with second-line therapy if required. Level of evidence: 4.

Management of Chyle fistula with Contrast Instillation: a Case Report

Chyle fistula is a rare condition, associated with loss of fluids, electrolytes, nutrients, lymphocytes, and immune dysfunction. They are managed by dietary modification or by surgical treatment. A case of chyle fistula developing after nephrectomy for non-functioning kidney is reported, along with various management modalities. A novel technique of fistula closure by contrast instillation is described. Patient is well after 2 years of surgery.

031. COMPELLING CASE OF COPPER CONUNDRUM: OCCIPITAL HORN SYNDROME

Background: Occipital horn syndrome (OHS) is a very rare, X-linked genetic disorder. There are 20 cases reported. It is a disorder of copper metabolism caused by missense mutations in the ATP7A gene, leading to toxic cellular accumulation of copper. This is the less severe phenotype of the condition known as the childhood variant of Menkes disease. We present a case report of a male with this syndrome who evaded clinical diagnosis for many years, with interesting radiological findings of rib notching which has not been associated with this condition. Methods: A 25 year old male presented with a diaphyseal skeletal dysplasia with abnormal carpal bones, radial shortening, humeral abnormalities, abnormal femoral head development and exostoses. Of note were inferior and superior rib notching. As a child, he was noted to have hypotonia, skin laxity, hyper-extensible joints and delayed developmental milestones. During his teenage years, he suffered from short stature and delayed puberty. He had experienced considerable myalgia and polyarthralgia with associated weakness compounded by pain and fatigue. He required multiple surgical interventions for para-umbilical, femoral and inguinal hernias since infancy. He was treated for multiple bladder infections secondary to diverticula; leading to numerous surgeries, including a left sided nephrectomy for non-functioning kidney. He was diagnosed with mitral valve prolapse as a child. Recently, he has suffered from short lived irregular palpitations with dyspnoea, triggered by posture changes. He had prolonged QTc interval on electrocardiogram but cardiac MRI was unremarkable. On examination, he demonstrated a long neck and forehead with narrow face, elevated arched palate and micrognathia. There was evidence of lax skin, reduced subcutaneous fat and markedly hypermobile joints. There was marked exostosis at the elbows with fused radial heads. He had narrow shoulders with expanded clavicular-sternal joints, as well as pectus excavatum. Results: On specialist review of the patient’s skeletal imaging, large exostoses (calcifications) were found in his trapezius and sternocleidomastoid muscles. These are the characteristic occipital horns, which married together with the spectrum of the connective tissue phenotype led to confirmatory blood and genetic testing showing low plasma copper and caeruloplasmin as well as the pathogenic mutation. Subcutaneous copper histidine replacement injections have been tried in Menkes disease and it is thought to slow disease progression. The use of copper in OHS is less certain. Conclusion: Occipital horn syndrome is worth considering as a diagnosis in cases with specific connective tissue phenotypes and odd radiological features. Inferior and superior rib notching has a short differential list and OHS should be added to this. This case illustrates the need for multiprofessional specialist services including the clinical genetics department. Diagnosis is important to establish in terms of monitoring organ complications and to plan antenatal screening and treatments that may improve long-term outcome.

Transperitoneal laparoscopic nephrectomy of non-functional horseshoe kidney that could not be identified preoperatively in a child

Horseshoe kidney is the most common congenital fusion anomaly. Ureters being stuck between the isthmus and the intestines cause urinary stasis and lead to more common development of urinary tract infection and urolithiasis compared to a normal kidney. If not treated, kidney function may be gradually lost. Although the condition is usually diagnosed with ultrasound screening, the diagnosis may be overlooked in patients with a non-functional kidney due to the lack of renal vascularization. We aim to present a 6 years old boy who have non-functioning kidney which is a part of undiagnosed horseshoe kidney. We emphasize that horseshoe kidney should be suspected when live renal parenchyma tissue passing the midline is observed during laparoscopic nephrectomy of a non-functional kidney that could not be preoperatively diagnosed as a horseshoe kidney in this presentation.

Retroperitoneo scopic nephrectomy on the treatmet of non-functioning kidney with hydronephrosis(Report of 5 cases)

Objective To evaluate the operation method and results of retroperitoneoscopic nephrectomy on the treatment of non-functioning kidney with hydronephrosis.Methods Retroperitoneoscopic nephrectomy was performed in 5 cases with nonfunctioning kidney with hydronephrosis.The retroperitoneal cavity were established with the fingers separating method.Afterwards ,3 Trocars were inserted through lumbar ports,the kidney was liberated partially,and made a small hole,the intrarenal fluid was drawn out.Then the kidney was liberated fully,the renal pedicle were exposed,and blocked with titanium clips or Hem-o-lok and then cut off,the non-functioning kidney was taken out in a specimen bag.Results The 5 operations were successful.The mean operative time was 170 min(150-300 min),and blood loss was 30 ml(10-80 ml).Drainage tube was removed 2-3 days after operation,we have not found any massive hemorrhage,infection,peritoneum rupture,intraabdominal visceral injury,and other severe complications.Conclusion Retroperitoneoscopic nephrectomy for non-functioning kidney with hydronephrosis is proved to be ninimal invasive,safe,effective,and rapid recovery.It would become the first choice for this kind of disease. Key words: Retroperitoneoscopic; Non-functioning kidney with hydronephrosis; Nephrectomy

Non-Iatrogenic Ureteric Injuries in Children: Single Center Experience

Purpose Non-iatrogenic ureteral injuries include those resulting from blunt trauma, stab wounds and gunshot wound. This type of ureteric trauma is extremely rare, occurring in 1% of all genitourinary trauma. We reviewed our experience in diagnosis and treatment of non-iatrogenic ureteric injuries in children over 15 years. Material and Methods From 1990 to 2005, ten children were treated for non-iatrogenic ureteric injuries. Patients characteristics, mechanism of trauma, affected ureteric segment, time of recognition, associated injuries, presentation, mode of treatment and postoperative complications were studied from the medical records of those patients. Results Ten non-iatrogenic ureteral injuries were repaired over 15 years. Five males and 5 females with median age 8 years (range 2-16). Right side was affected in 6 children. Blunt abdominal trauma was accused in 8 children while in two children penetrating trauma was inflicted (stab wound). Associated injuries were documented in 4 children- two of the penetrating trauma and two from the 8 blunt trauma. The affected segment was PUJ in 7 children, mid ureter in 2 and juxtavesical in one child. Urinoma was the presentation in all cases and diagnosis was established by reterograde pyelography in 4 children while PCN and antegrade pyelography in the others. In 4 children to whom retrograde pyelography was done, JJ stent was applied for 3 months in addition to percutaneous drain in 2 while ureterovesical reimplantation and A-H pyeloplasty in the others. In children to whom percutaneous nephrostomy was performed for 3-6 months, three necessitate nephrectomy for non functioning kidneys, two were treated by ureterocalyceal anastomosis and the other child was managed by ureteroureterostomy. Conclusions Pediatric non-iatrogenic ureteral injuries are extremely rare but can be devastating and/or challenging according to the subsequent fibrosis and the state of kidney function and also delay in diagnosis of those patients will increase the risk of complications.

Surgical treatment and outcome of mega-hydronephrosis due to pelviureteric junction stenosis

To study the surgical treatment and outcome of hydronephrosis secondary to pelviureteric junction obstruction (PUJS) that is so massive that the renal pelvis crosses over the vertebral column [mega-hydronephrosis (MH)]. Of the 40 cases of PUJS we treated over the past 5 years, 6 cases had MH secondary to PUJS (MH-PUJS) in 6 renal units and were reviewed. Incidence of MH was 15.0%. All had Anderson-Hynes dismembered pyeloplasty to treat obstructive renal pattern on technetium-99m diethylenetriaminepentaacetic acid (DTPA) scans in five and gait disturbance due to MH in one. The contralateral kidney was normal in five and dysplastic in one. Three had nephrostomy before pyeloplasty. Preoperative DTPA scans showed good renal function in four and poor in two. Plication of the entire dilated, lax renal parenchyma ("nephroplication") was performed in three to decrease the intra-renal pelvic cavity. Prenatal diagnosis was performed in three cases. Mean age at pyeloplasty was 3.5 years and mean duration of follow-up was 1.5 years. Postoperatively, two of the three who did not have nephroplication had prolonged but not obstructed renal pattern on DTPA scans, and the other case who did not have nephroplication had nephrectomy for non-functioning kidney caused by recurrent pyelonephritis 2 years after pyeloplasty. In the three who had nephroplication, DTPA scans showed acceptable to relatively good passage in all cases. The surgical treatment of MH-PUJS is challenging with no fixed guidelines. However, nephroplication may be useful during pyeloplasty to decrease the size of MH-PUJS.

An unusual presentation of genitourinary schistosomiasis in a Caucasian woman in the UK

A young woman who presented with loin pain and pyuria after a prolonged period of investigations and treatment, finally having a nephrectomy for non-functioning kidney, was revealed to have schistosomial infestation with an adult worm in the ureter. Unusually, she only developed bladder manifestations later.