Nonfunctioning Kidney Research Articles

De novo Stone Formation in Ureteric Stump Post-Nephrectomy

Introduction: The leftover ureteric stump after a simple nephrectomy is rarely symptomatic. Here, we report a unique case of ureteric stump stones that likely developed de novo and patients became symptomatic. Case Report: We report the case of a 53-year-old female, who had benign right nephrectomy for a nonfunctioning kidney 17 years ago and presented with three years history of recurrent urinary tract infections and right-side abdominal pain. A continuous unenhanced computed tomography scan confirmed the presence of multiple de novo stones in the leftover ureteric stump, which was successfully treated by an open transperitoneal ureteric stumpectomy. She was asymptomatic at 12 months post-operative follow-up. We describe problems of leftover ureteric stumps and the possible pathophysiology of the stones formation in this group of patients. Conclusion: Albeit rare, various symptoms and complications can develop in the leftover stump, including stumpitis, urinary tract infections, and calculi. Therefore, discussion with patients of ureteric stump complications is recommended.

Analysis of causes of graft loss in 135 kidney transplant recipients

To investigate the causes of graft loss in kidney transplant recipients. We retrospectively analyzed the clinical data of 135 recipients with graft loss after renal transplantation in the Eighth Medical Center of Chinese PLA General Hospital from January 1, 2002 to January 1, 2022. A total of 135 kidney transplant recipients experienced graft failure. The causes of graft loss included graft rejection (70 cases, 51.8%), death of the recipients with functional graft (37 cases, 27.4%), surgical complications (12 cases, 8.9%), drug toxicity (4 cases, 3.0%), carbapenem-resistant Klebsiella pneumoniae infection (4 cases, 3.0%), polyoma BK virus-related nephropathy (3 cases, 2.2%), primary nonfunctioning kidney (2 cases, 1.5%), recurrence of primary disease (2 cases, 1.5%), and prerenal acute renal failure (1 case, 0.7%). The main cause of graft loss after renal transplantation is graft rejection, and the secondary cause is death of the recipient with functional graft, and other reasons can be rare.

General Surgery and Spinal Anesthesia

Anesthesia and anesthetist are the co-worker to surgery. Surgeon and anesthetist with other subordinates is the surgical team. Patient satisfaction, surgical comfort to surgeon, patient, anesthetist and surgical team is the main stray and key point to select the type anesthesia to be given to particular individual. We had been doing a lot of general surgery under spinal anesthesia. Here main focus is laid down on gall bladder and renal surgery, which are relatively difficult to get done in spinal anesthesia without good co-operation of anesthetist. We had been doing renal and gall bladder surgery under spinal for the last more than 40 years, as there used to have no anesthetist in peripheral hospitals of Nepal, so giving spinal anesthesia by self and then doing surgery was the trend, which is now changed, as well-trained anesthetists are now available even in every big peripheral hospital of the country. We are presenting a record of last 10 years of renal and gall bladder surgery done under spinal anesthesia. We have done total 248 cases of renal stones including 12 nephrectomies for gross hydronephrosis with nonfunctional kidney big mass and 355 cases of open cholecystectomy through classical transverse subcostal incision.

Choosing the Best Treatment for Grade IV Renal Injuries that Are Isolated and Not Isolated

Objective: Grades I to III are the most common kidney injuries, and they are successfully treated non-operatively with high functional preservation. The objective of this study was to review all grade IV renal injuries and report outcomes. It also sought to ascertain whether operative and selective non-operative management could result in high salvage rates and whether management and outcomes varied noticeably between cases of isolated grade IV renal injuries and those with concomitant multi-organ injuries. Method: The data of 50 grade IV kidney injuries that occurred at Department of Urology, Rajendra Institute of Medical Science, Ranchi for ten years. These were split into two groups: those with isolated grade IV renal injuries (30) and those with accompanying nonrenal injuries (20), and both groups were analyzed with regard to the kind of renal injury, operative vs. nonoperative care, operational nephrectomy rate, and operational renal salvage rate. Salvage was defined as having a 50% or greater function of the injured kidney and an overall renal function of at least 20%. Results: With an overall salvage rate of 83%, 35 of the 50 patients were operated on and 15 were not. 35 injuries were caused by penetrating trauma, 10 by blunt trauma, and 5 out of 50 (51%) were renal vascular injuries. Grade IV renal injuries requiring operational exploration that also had concurrent related injuries were healed at exploration with a 14% nephrectomy rate and an 82% salvage rate. With an average transfusion need of 8.5 units packed red blood cells, 15 (41%) of the 30 patients with isolated injuries required surgical exploration. One patient (10%) required a nephrectomy, two kidneys were postoperatively nonfunctional, and one mild complication was found. Only 10 patients needed transfusions (average 2.5 units), and 87% of the remaining 20 isolated grade IV renal injuries were handled nonoperatively. There was no need for delayed nephrectomy in any of the 35 nonoperative patients of solitary or nonisolated renal injury. Three individuals had minimal problems, while five cases had non-functioning kidneys. Conclusion: Since isolated grade IV renal injuries provide a special case where the patient must be treated purely based on the severity of the renal injury, nonoperative therapy is applied more frequently. The primary reason for exploring and reconstructing the kidneys is persistent bleeding. Non-operative therapy should only be used in all cases of severe renal damage when patients are hemodynamically stable and have undergone full renal staging.

Osseous Metaplasia with Bone Marrow Elements in the Parenchyma of a Non-functional Kidney: A Case Report

Osseous Metaplasia with Bone Marrow Elements in the Parenchyma of a Non-functional Kidney: A Case Report

PS-R04-2: A CASE OF SUCCESSFUL PERCUTANEOUS TRANSLUMINAL RENAL ANGIOPLASTY (PTRA) FOR RENAL ARTERY STENOSIS ASSOCIATED WITH TAKAYASU'S ARTERITIS

Introduction: In Japan, renal vascular hypertension based on renal artery stenosis (RAS) accounts for 1% of all hypertensive patients, and RAS is present in approximately 10% of autopsy cases of coronary artery disease and cerebrovascular disease. As ischemic nephropathy and complications of cardiovascular disease (CVD) due to RAS are common, early diagnosis and treatment for RAS is important. However, results of several large clinical trials have not shown the efficacy of percutaneous transluminal renal angioplasty (PTRA) for atherosclerotic RAS. Case: 51-year-old woman who diagnosed as Takayasu's arteritis (TA) 35 years ago, had been treated with 5 mg daily of prednisone. She presented with hypertension and edema in both legs a year before admission. Her examination at that time revealed increased serum creatinine from 1.0 to 1.7 mg/dL, high proteinuria (7.3 g/gCr), high renin activity (47.0 ng/mL/hr) and right RAS. Eight months before admission, she had an operation for ruptured descending aorta. She had recurrent episodes of dyspnea on exertion, worsening leg edema and severe hypertension and was admitted to the hospital for the treatment. Clinical course: In addition to severe hypertension (190/80 mmHg) and progression of RAS, she had pulmonary congestion, high brain natriuretic peptide (BNP) level (1149.5 pg/mL), increasing creatinine levels (Cr 3.1 mg/dL), and left non-functioning kidney on admission. Despite taking 8 types of antihypertensive drugs and diuretics without renin-angiotensin system inhibitors, blood pressure and fluid retention were poorly controlled, and thus we decided to perform PTRA for the right RAS. After the PTRA, edema, hypertension and pleural effusion had been dramatically improved. In addition, we could observe decrease of serum creatinine (Cr 1.6 mg/dL), proteinuria (0.5 g/gCr) and plasma renin activity (1.9 ng/mL/hr). Therefore, we reduced the antihypertensive drugs from 8 to 2. Discussions: Although the benefit of PTRA for RAS associated with TA remains unclear, the clinical course suggests that the success of PTRA in this case may be related to the fact that the RAS was complicated by TA. It also suggests that we should consider PTRA in cases of hypertension and pulmonary congestion associated with RAS which are difficult to control like this case. Conclusion: We have experienced a case of RAS associated with TA that was successfully treated with PTRA.

Prognostic Evaluation of Minimally Invasive Laparoscopic Nephrectomy for Non-Functioning Kidneys

Prognostic Evaluation of Minimally Invasive Laparoscopic Nephrectomy for Non-Functioning Kidneys

Encrusted ureteral double J stents risk factors: A retrospective study

Background: The consequences and potential complications of encrusted double J (DJ) stents can be devastating. This work retrospectively reviews a series of Yemeni patients with encrusted DJ stents and shares the experience of handling such a challenging subject. Materials and Methods: A retrospective study was carried out from January 2016 to February 2021 at the Urology center, 48 Model Hospital, and Al-Khamseen Hospital, Sana’a, Yemen. About 30 patients with encrusted DJ stents for more than six months treated with various urological procedures were included in this study. The demographic characteristics, duration and indication of DJ stent placement, and surgical intervention were gathered and analyzed. Univariate analysis was performed to determine risk factors of long-standing encrusted DJ stent. Result: The mean age of patients was 31± 12.4 years (range 5–69), including 20 (66.7%) males and 10 (33.3%) females. The mean duration of DJ stents was 31.8± 20.8 months (12–120 months). The most common cause of long-standing encrusted DJ stent was poor compliance in 15 (50%) patients, followed by ignorance of DJ stent in 11 (36.7%) patients, and inability to access the hospital in 4 (13.3%) patients. Extracorporeal shock wave lithotripsy (ESWL) was the most common intervention performed in 11 (36.7%) patients as a single procedure. Multiple sessions of ESWL with another endourological procedure were required in 10 (33.3%) patients. A nephrectomy was performed on one (3.3%) patient due to a nonfunctional kidney. In univariate analysis, a longer duration of DJ stenting was associated with the need for multiple treatment modalities (p= 0.001). Factors such as poor compliance and farming community were associated with encrusted DJ stents in the female gender (p <0.05). In the male gender, ignorance of DJ stents was associated with encrusted DJ stents (p <0.05). Conclusion: A longer duration of DJ stenting is associated with worse outcomes, including DJ encrustation and the need for invasive and multiple treatment modalities. Poor compliance, residing in farming communities, and ignorance of the DJ stents are associated with long-standing encrusted risks and should be considered by the treating physicians.

Case Report of Bilateral renal agenesis (Potter s syndrome) at 26 weeks gestational age.

Case report: 19 years old PG married for 1 year, her husband is her cousin. No family history of congenital anomalies, No significant past medical history nor drug history. She as referred for anomaly scan, the pregnancy was uneventful till referral she was on good antenatal care received folic acid supplement. Ultrasound findings: Single, viable, breech presentation. Posterior high placenta Anhydramnios GA by ultrasound 26+3days (HC:28+6, FL:24+3, AC: 24+4) Congenital anomalies: Hydrocephalus (severe ventriculomegaly measuring 22cm, normal is <10cm Dilated third ventricle (6mm) thalami are not seen well. Both kidneys show features of multicystic changes No cortico-medullary differentiation. Bladder filling is not seen Conclusion A picture suggestive of bilateral non-functioning kidneys. Hydrocephalus. No major anomaly seen however other anomalies can’t be excluded due to poor visualization. Impressionvery poor outcome.

Histopathological study of various nephrectomy specimens received at tertiary care hospital: A retrospective study

Introduction: The Kidney is one of the most highly differentiated organs in the body affected by various disease processes, some resulting in permanent damage leading to surgical removal of kidney i.e., nephrectomy. Indications for nephrectomy are varied including irreversible damage by chronic infections, obstructive causes stricture and calculus diseases, vesicouretric reflex, congenital displasia, nephrosclerosis, cystic disease and also severe traumatic injury, non corrective renal artery disease leading to renovascular hypertension. Simple nephrectomy is done to remove the irreversibly damaged, non-functioning kidneys involved by different benign pathologic condition while radical nephrectomy is indicated in malignant lesion.Aim: To assess the patterns and morphology of lesions in nephrectomy specimens in a tertiary care hospital.Material and MethodThis retrospective study carried out in the Department of Pathology in B.J. Medical college and civil Hospital, Ahmedabad, Gujarat, India. A total of 63 nephrectomy specimens received during the period of 1 year and 5 months from January 2021 to may 2022 were included in the study. Paraffin blocks and slides along with case records were retrieved and studied.Results: Patients with a male to female ratio of 1.25:1. Maximum cases of chronic pyelonephritis were seen in the age group of 20-40 years. Among 63 nephrectomy cases, 38 cases were non-neoplastic lesions and 25 of the cases were neoplastic lesions. Among 25 cases of renal cell carcinoma, clear cell renal cell carcinoma (13) cases were the most frequent followed by papillary RCC (4) cases. Conclusion: Nephrectomy is an accepted surgical procedure for non-functioning kidneys due to various pathological disease processes. Most common affected age group was 20-40 years. Non neoplastic lesions were the most common cause for nephrectomies. Chronic pylonephritis with hydronephrotic changes being the most common cause. Clear Cell renal cell carcinoma being the common among malignant tumors. Other benign and malignant lesions being rare.

Evaluating the outcomes of 3D laparoscopic nephrectomy for bengin non-functioning kidneys

Abstract Introduction: Previous endoscopic systems with 2D (2D) screens provide the surgeon with an indirect vision. To inprove this, 3D laparoscopic surgery was perfomed and has become a breakthrough in the era of minimally invasive surgery with high image definition, stability, good depth sense, reducing the burden on the surgeon's vision. At Hue Central Hospital, since 2020 we have applied regularly 3D endoscopic surgery for urological kidney diseases but not too many research projects to evaluate the safety, effectiveness and applicability of these means. Therefore, we carried out the topic: "Evaluating the results of 3D laparoscopic nephrectomy due to benign pathology". Patients and methods: 3D LN was performed on patients diagnosed with non-functioning kidneys at Hue central hospital from 1/2021 to 11/2021. Variables including standard features, clinical, subclinical, preoperative and postoperative results, perception of surgeons after surgery and how 3D vision impact their emotional states, were recorded. In addition, the duration of operation between high and low BMI groups as well as the adhesion inflammation level in kidney were also analyzed and compared. Results: Samples included 17 cases, with male:female is 6:11. Mean age was 58.18 11.66 (32-85). All cases were performed by transperitoneal laparoscopic nephrectomies. Mean operation time was 136,76 37,66 minutes, average blood loss was 85,0 21,36 ml (50-120). Mean length of stay was 8,88 3,44 days (5-18). Mean VAS score was 6,57 1,42. Complications had 3 cases: 2 cases had pyonephrosis, 1 case had acute pancreatitis without re-operated need. High BMI, hydronephrosis or nephritis didnt impact excessively on operation time. We recorded diversity of side effects from 3D lapararoscopy such as headache, nausea with some initial cases. Average STAI-6 score was 12,88 2,67. According to feeling of surgeons, they concurred with image quality, depth perception, eye-hand coordination during surgery were acceptable. Conclusion: 3D laparoscopic nephrectomy is safe, efficient. Using 3D vision for laparoscopy in order to obtain better image quality, has more depth and improve eye-hand coordination rather than 2D system. Keywords: Laparoscopic nephrectomy; 3D laparoscopy; non-functioning kidney.

Silent Kidney Loss Associated with Endometriosis; A Case Report & Literature Review

Background: Ureteral endometriosis commonly presents with non-specific symptoms or no symptoms. Diagnostic challenges are multifactorial but essentially caused by diagnostic delay due to the silent nature of the disease. Management requires a multidisciplinary approach to optimise the outcome. Case Report: A 29-year-old woman presented with severe deep infiltrating endometriosis resulting in bilateral hydronephrosis and loss of left kidney function. Laparoscopic excision of deep infiltrating endometriosis, ureterolysis, bowel resection and colostomy formation were performed. Eventually the left non-functional kidney required nephrectomy. Conclusion: The presence of posterior deep infiltrating endometriosis with uterosacral involvement should increase clinical suspicion of ureteral endometriosis and trigger targeted investigations. The best outcome is achieved by the individualisation of patient’s care.

Clinical case of hydronephrotic form of multicystic dysplastic kidney complicated by pyelonephritis in adults

Multicystic dysplastic kidney (MCDK) is a renal dysplasia characterized by the presence of multiple cysts that are non-communicating, varying in size, separated by dysplastic parenchyma that consume the renal cortex resulting in a non-functional kidney with the absence of a normal pelvocaliceal system. The incidence of MCDK is approximately 1 : 4300 of live births, with males being affected more often than females. Many concurrent urinary tract abnormalities have been described in patients with MCDK. The most common and potentially significant urologic defect seen is vesico-ureteral reflux to the contralateral kidney. In our clinical case, multicystic dysplastic kidney complicated by hydronephrotic transformation and septic obstructive pyelonephritis, which developed on the base of undiagnosed vasorenal conflict.

Histomorphological Analysis of Nephrectomy Specimens

Introduction: For a range of kidney abnormalities, including both neoplastic and nonneoplastic disorders, nephrectomy is a popular surgical treatment. We conducted this study to examine the range of lesions found in the nephrectomy specimens obtained and to ascertain the distribution of these lesions by age and sex. Materials and Methods: This study was conducted in the department of pathology, from 2017 to 2022. All nephrectomy specimens received during 5 years were included. Results: The spectrum of renal lesions observed in the study included both neoplastic (43.75%) and nonneoplastic (56.25%) conditions. Nineteen patients were males (59.37%) and 13 were females (40.62%) (M: F = 1.4:1). The most common entity in the nonneoplastic category was chronic pyelonephritis (n = 9, 28.12%). In our study, we documented two unusual cases of renal replacement lipomatosis (RRL), a type of pseudotumor related to nonfunctioning kidneys. Fourteen patients underwent nephrectomy for neoplastic conditions such as Wilm's tumor and renal cell carcinoma (RCC). Conclusion: Nephrectomy for the nonneoplastic condition was performed more frequently in our series. Histopathological evaluation of nonneoplastic nephrectomy specimens must be thoroughly considered, particularly in unusual circumstances such as RRL, where a preoperative erroneous initial impression of a malignant lesion such as angiomyolipoma or liposarcoma is possible.

Ускоренное выздоровление при простой лапароскопической нефрэктомии.

Introduction. Simple nephrectomy is used for non-cancer diseases. That is, when the preservation of the kidney is unreasonable or dangerous. Since simple nephrectomy is a typical organ-delivering surgery, it is possible to optimize the perioperative period to reduce hospitalization and disability. The aim of the study was to compare the outcomes of simple laparoscopic nephrectomy using the enchanted recovery protocol and the standard approach. Materials and methods. A prospective randomized multicenter study included 27 patients with an established diagnosis of a non-functioning kidney, who were treated in the period 2018–2021 in urological hospitals in the city of Irkutsk. All patients were divided into two comparison groups: STANDART group (group I, n=14) and ENCHANCED RECOVERY group (group II, n=13). Results. Primary efficacy was comparable (p=0.892). It was found that the level of complications of class III according to Clavien-Dindo was statistically comparable in both groups (p>0.05), and the level of complications of class II was significantly higher in group I (p<0.05). When comparing the duration of hospitalization, there is a significantly (p <0.001) longer stay of patients in group I (9.5±2.2 days) compared to group II (1.0±0.0 days). Subjective satisfaction with the treatment performed (upon requesting a critical analysis of all possible complaints) was comparable and amounted to 57.1% for group I and 100% for group II (p=0.342). When conducting a logistic regression analysis for postoperative febrile condition, according to multivariate regression, the volume of intraoperative infusion was found to be a significant predictor (for each +1 ml; OR 0.003; 95% CI 0.0001; 0.005; p = 0.042); for postoperative pain syndrome >5 VAS points – increase in the size of the surgical approach per 1 mm (OR 0.14; 95% CI -0.01; 0.307; p = 0.077); for satisfaction with treatment, a negative effect of the duration of the postoperative stay was found (for each +1 day; OR -1.08; 95% CI -2.32; 0.15; p = 0.086). Conclusion. Simple laparoscopic nephrectomy under the enchanted recovery protocol allows achieving similar treatment results without increasing the risk of readmission or reoperation, but with the achievement of a better subjective and objective postoperative status of the patient.

Nephrectomy in Children: A Single Center Experience

Background: The surgical removal of the kidney, nephrectomy, is not a minor surgical procedure. It is a major endeavor. Indications for nephrectomy range from benign to malignant pathological conditions. Materials and Methods: This was a retrospective study of children aged 15 years and below who had nephrectomy between January 2016 and December 2020 at the pediatric surgery unit of a teaching hospital in Enugu, Nigeria. The information extracted included the age of the patient at presentation, gender, and predominant presenting symptom and the pathology (indication), duration of symptoms before presentation to the hospital, time interval between presentation and nephrectomy, operative procedure performed complications of treatment, duration of hospital stay and outcome of treatment. Results: Eighteen (18) pediatric nephrectomies were performed during the study period. There were 14 (77.8%) males and 4 (22.2%) females. The mean age of the patients was 6 years with a range of 3 years to 9 years. Nephroblastoma was the most common indication (pathology) for nephrectomy. Nephrectomies were performed more on the left side than on the right. Simple nephrectomy was performed in all the patients. However, children with nephroblastoma had nephroureterectomy. Surgical site infection was the most common post-operative complication. About one-quarter of the patients expired due to tumor metastasis. Conclusion: Nephrectomy is the optimal procedure for neoplasm of the kidney or non-functional kidney. Malignant kidney tumour (nephroblastoma) was the most common indication for nephrectomy in the present study.

Incidental renal neoplasia following simple nephrectomy of the non-functioning kidney. Is it more common than previously reported?

Background: Simple nephrectomy is a technique of removing the kidney from within the gerota’s fascia and is usually for a non-functioning kidney. While for renal tumors, radical nephrectomy is done, which involves the removal of the kidney with gerota’s fascia along with the ureter. Histopathology of patients who undergo simple nephrectomy sometime reveals renal malignancy. Such patients often need further treatment as simple nephrectomy in such cases is mostly suboptimal. The number of studies reporting tumors in simple nephrectomy specimens is limited. We aim to report single-center pathological findings in nephrectomy specimens from patients treated for non-functioning kidneys due to renal stone disease. Methodology: The medical record of patients (n=210) who underwent simple nephrectomy between 2014 and 2021 at the Kidney Centre Postgraduate Training Institute due to renal stone disease was reviewed retrospectively. Results: The total number of patients undergoing simple nephrectomy for non-functioning kidneys due to stone disease was 210. Of those patients, 117 were males, and 93 were females. The mean age was 45.33 ± 17.65 years. The histopathology report of specimens revealed renal malignancy in 10 patients (4.76%), xanthogranulomatous pyelonephritis in 11 patients, tuberculosis of the kidney in 7 patients, and chronic pyelonephritis in 182 patients. Conclusion: In conclusion, the prevalence of renal malignancy in patients undergoing simple nephrectomy is significantly high.

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

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

Robot-assisted surgery in horseshoe kidneys: A safety and feasibility multi-centre case series

Objective: We assessed the safety and feasibility of minimally invasive robot-assisted surgery for horseshoe kidney (HSK). Method: A prospectively maintained data set for consecutive patients undergoing robotic kidney surgery was reviewed for patients with HSK. Cases were performed by experienced robotic surgeons, across two high-volume centres between 2016 and 2020. Results: Seven patients underwent robotic surgery for HSK, comprising three partial nephrectomies for renal masses, one nephroureterectomy and three benign nephrectomies for non-functioning kidneys. The median age was 53 (interquartile range (IQR) = 47–60) years and median body mass index (BMI) was 25 (IQR = 25–26.5). Median console time was 120 (IQR = 118–215) minutes and median estimated blood loss was 150 (IQR = 125–250) mL. The median pre- and post-operative estimated glomerular filtration rate (eGFR) was 76 (IQR = 72–90) and 71 (IQR = 60–81), respectively. There were no higher-grade complications (Clavien–Dindo III–IV) and one Clavien–Dindo grade II complication (wound infection treated with IV antibiotics). Median length of stay (LOS) was 2 days and there were no 30-day readmissions. Negative margins were achieved in 75% of tumour resections. Conclusion: We report one the largest series of robot-assisted surgery on HSK. Robotic surgery is safe and feasible for HSK in centralised high-volume centres with acceptable perioperative outcomes. Established benefits of minimally invasive surgery, such as reduced LOS and low complication rates, were demonstrated. Level of evidence: 4

Histopathological Spectrum of Nephrectomies; a Single Centre Experience of over 14 Years

Nephrectomy is conducted either as an open or a laparoscopic procedure for a variety of clinical indications. These include both neoplastic and non-neoplastic conditions, such as the non-functioning kidney. In many patients the final diagnosis is established on the histopathology of the retrieved kidney. In this study, retrospective analysis of data of last 14 years was studied pertaining to the number and indications of nephrectomy at the present study centre. Demographic and clinical details were assessed. Gross and microscopic histopathological details were recorded. Diagnosis was established on the basis of clinical features and histopathology. A total of 638 total nephrectomy specimens were received. Of these, 280 cases were of neoplastic and 358 of non-neoplastic lesions, with a male-to-female ratio of 1.21:1. The age range varied widely according to clinical manifestations. The age range in the present study was 5–84 years. Patients operated for non-neoplastic disorders were younger (mean age: 38.1 years) than those operated for neoplastic disorders (mean age: 54.4 years). Clear renal cell carcinoma (RCC) was the commonest RCC type (150 patients) followed by papillary RCC (51 cases). Nephrectomy is done due to both benign and malignant clinical indications as observed in this study. The most common indication was chronic pyelonephritis with the non-functioning kidney.