Postoperative Glomerular Filtration Rate Research Articles

Perioperative, Oncological, and Functional Outcomes after Retroperitoneal Laparoscopic Partial Nephrectomy in Elderly Patients: A Propensity Score Matching Analysis.

Purpose: We aimed to assess the perioperative, oncological, and functional outcomes of patients aged 70 years or older following retroperitoneal laparoscopic partial nephrectomy (LPN) and compare their results with younger patients. Materials and Methods: A retrospective review of our prospectively maintained database identified 329 patients who underwent retroperitoneal LPN from January 2013 to October 2022. The patients divided into 2 groups defined by age ≥70 or <70 years at the time of surgery. A propensity score matching analysis was conducted to obtain two balanced groups. The groups were compared for safety (perioperative outcomes) and efficacy (oncological and functional outcomes). Results: After matching, all variables were well balanced with no differences between the two cohorts. No significant differences were found in perioperative outcomes, including operative time, warm ischemia time, blood loss, hospital stay, and complications (P values >.05). Concerning functional outcomes, postoperative glomerular filtration rate and decrease in glomerular filtration rate were significantly better in the younger group compared with the elderly groups (P = .003 and P = .001, respectively). Although margin, ischemia, complications rates were similar between the cohorts (P = .068), Pentafecta rates were lower in the elderly patients (P = .029). In terms of oncological outcomes, recurrence-free survival and cancer-specific survival were comparable between the groups. Conclusion: Retroperitoneal LPN can be performed safely and with adequate oncological efficacy in elderly patients.

Correlation between bilateral GFR in patients with localized renal cancer after partial nephrectomy.

To explore the relationship between the residual glomerular filtration rate (GFR) on the operated side and the GFR on the contralateral side following partial nephrectomy (PN) in patients with localized renal cell carcinoma (RCC). Following institutional review board approval, we conducted a retrospective analysis of clinical records from May 2018 to July 2023, involving 118 patients who underwent partial nephrectomy for unilateral localized kidney tumors (T1-T2). Glomerular filtration rate data were assessed using single photon emission computed tomography (SPECT)/computed tomography imaging [using 9mTc-DTPA (diethylenetriaminepentaacetic acid) renal dynamic imaging]. The independent determinants of postoperative renal function or renal function change were determined using linear regression analysis. In addition, the patient's demographic, clinical, and nephrometry characteristics were collected. A total of 58 patients were finally enrolled. The preoperative and postoperative GFR of bilateral kidneys showed a significant positive correlation. Postoperative GFR of the operated kidney was the independent predictor of GFR of contralateral kidney (p = 0.001). Tumor diameter (p = 0.036), age (p = 0.005), and postoperative GFR of the contralateral kidney (p = 0.001) were all independent predictors of postoperative GFR of the operated kidney. ΔGFR1 was the independent predictor of ΔGFR2. Results showed that a more pronounced postoperative decline in GFR on the operated side corresponded to a weaker compensatory capacity of the contralateral-side kidney. During the course of the surgical procedure, the active endeavor to safeguard the renal function of the operated kidney side holds paramount importance, which yields positive outcomes for postoperative kidney function on the contralateral side, consequently contributing to the overall preservation of renal function.

Clinical study of renal artery cold perfusion combined with laparoscopic nephron retention in the treatment of complex renal angiomyolipoma.

The aim of this study is to summarize the surgical experience of renal artery cold perfusion combined with laparoscopic nephron preserving surgery for the treatment of complex renal angiomyolipoma and to evaluate the safety and feasibility of this surgical protocol. Clinical data of nine patients who received renal artery cold perfusion combined with laparoscopic nephron preserving surgery for complex renal angiomyolipoma in our hospital from February 2017 to August 2020 were retrospectively analyzed. The study parameters included imaging findings, total renal function before and after surgery, glomerular filtration rate (GFR) of affected kidney before and after surgery, and related complications. Eight of the nine patients successfully completed the operation, one patient was intolerant to renal artery balloon implantation, and the success rate of the operation was 88.89%. The mean maximum tumor diameter was 6.8 cm, and RENAL score was 7 points. Postoperative total renal function and GFR of the affected kidney had no significant changes compared with that before surgery, and imaging examination showed no tumor residue or recurrence. This surgical procedure is safe and feasible for complex renal angiomyolipoma and can be used as a surgical option for renal hamartoma. The long-term effect needs to be confirmed by further studies.

Volumetric and functional outcomes at 1-year between percutaneous-ablation and partial-nephrectomy for T1b renal tumors.

Indication for percutaneous-ablation (PA) is gradually expanding to renal tumors T1b (4-7cm). Few data exist on the alteration of renal functional volume (RFV) post-PA. Yet, it is a surrogate marker of post partial-nephrectomy (PN) glomerular filtration rate (GFR) impairment. The objective was to compare RFV and GFR at 1-year post-PN or PA, in this T1b population. Patients with unifocal renal tumor≥4cm treated between 2014 and 2019 were included. Tumor, homolateral (RFVh), contralateral RFV, and total volumes were assessed by manual segmentation (3D Slicer) before and at 1 year of treatment, as was GFR. The loss of RFV, contralateral hypertrophy, and preservation of GFR were compared between both groups (PN vs. PA). 144 patients were included (87PN, 57PA). Preoperatively, PA group was older (74 vs. 59years; P<0.0001), had more impaired GFR (73 vs. 85mL/min; P=0.0026) and smaller tumor volume(31.1 vs. 55.9cm3; P=0.0007) compared to PN group. At 1year, the PN group had significantly more homolateral RFV loss (-19 vs. -14%; P=0.002), and contralateral compensatory hypertrophy (+4% vs. +1,8%; P=0.02, respectively). Total-RFV loss was similar between both (-21.7 vs. -19cm3; P=0.07). GFR preservation was better in the PN group (95.9 vs. 90.7%; P=0.03). In multivariate analysis, age and tumor size were associated with loss of RFVh. For renal tumors T1b, PN is associated with superior compensatory hypertrophy compared with PA, compensating for the higher RFVh loss, resulting in similar ΔRFV-total between both groups. The superior post-PN GFR preservation suggests that the preserved quantitative RFV factor is insufficient. Therefore, the underlying quality of the parenchyma would play a major role in postoperative GFR.

Clinical application of superselective transarterial embolization of renal tumors in zero ischaemia robotic-assisted laparoscopic partial nephrectomy.

To assess the feasibility and safety of zero ischaemia robotic-assisted laparoscopic partial nephrectomy (RALPN) after preoperative superselective transarterial embolization (STE) of T1 renal cancer. We retrospectively analyzed the data of 32 patients who underwent zero ischaemia RALPN after STE and 140 patients who received standard robot-assisted laparoscopic partial nephrectomy (S-RALPN). In addition, we selected 35 patients treated with off-clamp RALPN (O-RALPN) from September 2017 to March 2022 for comparison. STE was performed by the same interventional practitioner, and zero ischaemia laparoscopic partial nephrectomy (LPN) was carried out by experienced surgeon 1-12 hours after STE. The intraoperative data and postoperative complications were recorded. The postoperative renal function, routine urine test, urinary Computed Tomography (CT), and preoperative and postoperative glomerular filtration rate (GFR) data were analyzed. All operations were completed successfully. There were no cases of conversion to opening and no deaths. The renal arterial trunk was not blocked. No blood transfusions were needed. The mean operation time was 91.5 ± 34.28 minutes. The mean blood loss was 58.59 ± 54.11 ml. No recurrence or metastasis occurred. For patients with renal tumors, STE of renal tumors in zero ischaemia RALPN can preserve more renal function, and it provides a safe and feasible surgical method.

Impact of Particulate Matter With an Aerodynamic Diameter

Ambient air pollution has become 1 of the most important public health issues worldwide. In particular, particulate matter with an aerodynamic diameter <2.5 μm (PM2.5) is a fatal component of air pollution. We aimed to analyze whether perioperative exposure to PM2.5 is associated with the deterioration of renal function in living kidney donors. This study was conducted on 232 kidney donors with postoperative 2-year glomerular filtration rate (GFR). The GFR was determined by serum creatinine-based method using the Modification of Diet in Renal Disease equation and radionuclide-based method using 99mTc-DTPA renal scintigraphy. Perioperative exposure to PM2.5 was calculated using data from the AIRKOREA System. Multiple linear and logistic regression analyses were performed to estimate the associations between mean PM2.5 concentration and postoperative 2-year GFR. Postoperative Modification of Diet in Renal Disease-estimated GFRs of kidney donors with low PM2.5 concentrations were significantly higher than those of those with high PM2.5 concentrations. A 1-μg/m3 increase in mean PM2.5 concentration was associated with decreased GFR by 0.20 mL/min/1.73 m2. In addition, a 1-μg/m3 increase in mean PM2.5 concentration was associated with an 11% increased risk of chronic kidney disease stage ≥3 at 2 years after donor nephrectomy. In patients who underwent donor nephrectomy, exposure to PM2.5 negatively affects renal function and is positively associated with the prevalence of chronic kidney disease.

Evaluation of Renal Function Recovery After Holmium Laser Enucleation of the Prostate in Patients with Chronic Kidney Disease.

Introduction: Holmium laser enucleation of the prostate (HoLEP) has become a new surgical gold standard treatment for benign prostatic hyperplasia (BPH). It is known that untreated BPH can lead to bladder outlet obstruction (BOO). A positive correlation exists between BOO and chronic kidney disease (CKD), but stability or recovery of renal function after HoLEP remains unknown. We sought to describe changes in renal function after HoLEP in men with CKD. Methods: A retrospective study was conducted of patients who underwent HoLEP with glomerular filtration rates (GFRs) <60, CKD stages III to V. Pre- and postoperative GFRs were selected within 3 months before the operation and within 1 year postoperatively. The presence of an indwelling catheter, preoperative hydronephrosis, history of kidney stones, and prostate size were also reviewed. Data were analyzed in accordance with preoperative CKD stage. Results: Of the reviewed patients, 138 met inclusion criteria with CKD stages III to V. Each CKD group was without significant postoperative complications. There was a significant increase between pre- and postoperative GFR for patients in CKD stages III (n = 116) and IV (n = 17) (p < 0.0001 and p = 0.010, respectively). The mean increase between pre- and postoperative GFR for the CKD stages III and IV patients were 6.4 and 6.49, respectively. There was no correlation between presence of preoperative hydronephrosis, history of kidney stones, catheter dependency, nor prostate size on change in postoperative GFR (p > 0.05). Conclusion: These findings suggest that patients in CKD stages III or IV undergoing HoLEP experience an increase in GFR. It is noteworthy that there appears to be no decline in renal function postoperatively in any group. HoLEP represents an excellent surgical option for patients with preoperative CKD and may prevent further renal decline.

Choroidal Vascularity Index and Choroidal Thickness Changes Following Renal Transplantation.

This study aimed to evaluate changes in subfoveal choroidal thickness (SFCT), choroidal vascularity index (CVI), estimated glomerular filtration rate (GFR), mean arterial pressure (MAP), and intraocular pressure (IOP) after renal transplantation. A total of 49 renal transplantation patients were included in this prospective study. CVI and SFCT on enhanced-depth imaging optic coherence tomography (EDI-OCT), MAP at the cubital fossa, GFR, and IOP were measured preoperatively and at postoperative 1 week and 1 month. In the analysis of EDI-OCT images, luminal area (LA) and stromal area of the choroid were determined using the image binarization method. CVI was defined as the ratio of LA to total choroid area. The effects of GFR, IOP, and MAP on CVI and SFCT were investigated. The study included 23 women (47%) and 26 men (53%) with a mean age of 26.28±8.25 years (range: 18-52). Changes between preoperative, postoperative 1-week, and postoperative 1-month GFR values, CVI, and SFCT measurements were evaluated. There were significant differences between preoperative and postoperative GFR and SFCT measurements (p<0.001), but no significant differences between preoperative and postoperative CVI (p=0.09), MAP (p=0.14), or IOP (p=0.84) measurements. The present study demonstrated that SFCT increased significantly with GFR, while there was no change in CVI values.

PD08-06 FULLY AUTOMATED TUMOR CONTACT SURFACE AREA PREDICTS POSTOPERATIVE IPSILATERAL GFR PRESERVATION FOLLOWING PARTIAL NEPHRECTOMY

You have accessJournal of UrologyCME1 Apr 2023PD08-06 FULLY AUTOMATED TUMOR CONTACT SURFACE AREA PREDICTS POSTOPERATIVE IPSILATERAL GFR PRESERVATION FOLLOWING PARTIAL NEPHRECTOMY Andrew Wood, Nicholas Heller, Tarik Benidir, Nour Abdallah, Fabian Isensee, Resha Tejpaul, Chalairat Suk-Ouichai, Caleb Curry, Alex You, Erick Remer, Samuel Haywood, Robert Abouassaly, Steven Campbell, Nikolaos Papanikolopoulos, and Christopher Weight Andrew WoodAndrew Wood More articles by this author , Nicholas HellerNicholas Heller More articles by this author , Tarik BenidirTarik Benidir More articles by this author , Nour AbdallahNour Abdallah More articles by this author , Fabian IsenseeFabian Isensee More articles by this author , Resha TejpaulResha Tejpaul More articles by this author , Chalairat Suk-OuichaiChalairat Suk-Ouichai More articles by this author , Caleb CurryCaleb Curry More articles by this author , Alex YouAlex You More articles by this author , Erick RemerErick Remer More articles by this author , Samuel HaywoodSamuel Haywood More articles by this author , Robert AbouassalyRobert Abouassaly More articles by this author , Steven CampbellSteven Campbell More articles by this author , Nikolaos PapanikolopoulosNikolaos Papanikolopoulos More articles by this author , and Christopher WeightChristopher Weight More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003239.06AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Tumor Contact Surface Area (CSA) is an externally validated nephrometry scoring system that requires measurement of multiple dimensions of cross sectional imaging. Despite studies demonstrating its ability to predict glomerular filtration rate (GFR) following partial nephrectomy (PN), its implementation has been slowed by required time investment and interobserver variability. We sought to evaluate the utility of artificial intelligence (AI) generated CSA as compared to human-generated CSA in predicting post-PN GFR. METHODS: A total of 300 patients with preoperative computerized tomography with early arterial contrast phase were identified from a cohort of 544 consecutive patients undergoing surgical extirpation for suspected renal cancer. A deep neural network approach was used to automatically segment kidneys and tumors, and then programed to generate the measurements and calculate tumor CSA. Human CSA scores were independently calculated by medical personnel blinded to AI-scores. Ipsilateral GFR before and after surgery was calculated from volumetric analyses of kidney parenchyma and pre and post-operative GFR values. AI-CSA and Human-CSA were then compared with regards to their ability to predict Ipsilateral GFR preservation. RESULTS: After removal of patients undergoing RN and those without requisite data for GFR calculation, a total of 150 patients were included in the analysis. There was significant agreement between Human CSA and AI-CSA on linear regression analysis (R2=0.74, p<0.0001). On univariate linear regression analysis, both AI- (r=0.217, p=0.0076) and Human generated (r=0.187, p=0.021) CSA similarly predicted ipsilateral GFR preservation. However, when incorporated into a MV model incorporating age, gender, body mass index, diabetes status, and ischemia time, only AI generated tumor CSA remained a significant predictor of ipsilateral GFR preservation (p=0.021). CONCLUSIONS: Fully automated tumor CSA calculations are not inferior, and may be superior, to human generated CSA calculations in predicting post-operative GFR after PN. Once validated, our results suggest that AI generated CSA could be delivered automatically from a preoperative CT scan to a clinician and patient at the point of care to aid in decision making. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e234 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Andrew Wood More articles by this author Nicholas Heller More articles by this author Tarik Benidir More articles by this author Nour Abdallah More articles by this author Fabian Isensee More articles by this author Resha Tejpaul More articles by this author Chalairat Suk-Ouichai More articles by this author Caleb Curry More articles by this author Alex You More articles by this author Erick Remer More articles by this author Samuel Haywood More articles by this author Robert Abouassaly More articles by this author Steven Campbell More articles by this author Nikolaos Papanikolopoulos More articles by this author Christopher Weight More articles by this author Expand All Advertisement PDF downloadLoading ...

Radical cystectomy and urinary diversion outcomes in patients with single vs. double renal unit: A 2:1 matched-pair analysis.

To evaluate perioperative and functional outcomes of radical cystectomy (RC) and urinary diversion (UD) in patients with a single kidney (SK) vs. double kidneys (DK). We reviewed records of patients who underwent RC for bladder cancer with a history of prior or concurrent nephrectomy at USC 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 DK using 2:1 matching with respect to age, sex, preop GFR, and tumor stage. We included 186 patients (SK = 62 and DK = 124). 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. In patients with continent diversion, SK vs. DK showed similar 90-day complications (71% vs. 69%, P = 1.0). SK patients had significantly lower GFRs at discharge, 3-, and 12-month following RC compared to the DK group. Postoperative GFRs of the SK patients with continent vs. incontinent UD were statistically similar. On multivariable analysis, UD (i.e. continent vs. incontinent) was not associated with post-op GFR decline at discharge, 3- and 12-month following RC. Perioperative outcomes of radical cystectomy patients with single kidney are similar to double kidney patients, except for more GFR decline in single kidney cases. Continent urinary diversion in single kidney is as safe as double kidney patients.

V05-05 3D SURGICAL PLANNING IN PARTIAL NEPHRECTOMY FOR COMPLETELY ENDOPHYTIC TUMORS

You have accessJournal of UrologyCME1 Apr 2023V05-05 3D SURGICAL PLANNING IN PARTIAL NEPHRECTOMY FOR COMPLETELY ENDOPHYTIC TUMORS Patricio Garcia, Jorge Abril, Tomas Carminatti, Angelica Castillo, Sebastian Tirapegui, and Alberto Jurado Patricio GarciaPatricio Garcia More articles by this author , Jorge AbrilJorge Abril More articles by this author , Tomas CarminattiTomas Carminatti More articles by this author , Angelica CastilloAngelica Castillo More articles by this author , Sebastian TirapeguiSebastian Tirapegui More articles by this author , and Alberto JuradoAlberto Jurado More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003263.05AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: When we talk about precision surgery, it is necessary to have adequate preoperative planning. 3D technology allows us to locate renal lesions that are difficult to access, and in this way generate less damage to the uncompromised parenchyma.In recent years it has been seen that the incorporation of 3D models could improve surgical results, the learning curves of novice surgeons and also the understanding of patients.In Urology, the use of surgical planning with 3D models and simulation is mainly used in renal tumors. The objetive is to present a series of cases of completely endophytic renal tumors with 3D models created for surgical planning. METHODS: We present a series of 5 cases with 3D models created for surgical planning. Case #1A 47-year-old female patient with congenital solitary kidney, presents an incidental renal tumor of 2 cm completely endophytic in contact with the renal sinus, it is a R.E.N.A.L Score 9x. It was performed by lumboscopic approachCase #2 A 60-year-old male patient with bilateral renal tumors, has a Left renal exophytic formation and completely endophytic right renal lesion of 2 cm R.E.N.A.L. Score 10p. The exophytic left renal tumor was treated 3 months before. It was performed by a lumboscopic approach.Case #3A 61-year-old female patient with a completely endophytic mesorenal lesion in the left kidney of 2.5cm R.E.N.A.L. Score 12x. In this patient we performed a transperitoneal approach Case #4A 54-year-old male patient with a completely endophytic mesorenal lesion in the left kidney of 3cm R.E.N.A.L. score 12x. It was performed by a lumboscopic approach.Case #5. A 45-year-old male patient with a completely endophytic mesorenal lesion in the left kidney of 2.5 cm. RENAL Score 12x. In this patient we performed a transperitoneal approach RESULTS: In our hospital we did 21 minimally-invasive partial nephrectomy for completely endophytic tumors between 2010 to 2022. In the last year we incorporated the use of 3D technology for surgical planning in these cases.The average days of hospitalization was 2, 9. In the pathology reports, the majority of tumors were Clear-cell RCC and pT1a. Two patients had postoperative complications with Clavien dindo III.Negative margins, warm ischemia time <25 minutes, and postoperative glomerular filtration rate <15% were established as cut-off points with respect to the strict Trifecta criteria to ensure optimal preservation of renal function. We achieved strict trifecta results in 16 patients (76.19%) CONCLUSIONS: In our case series, 3D models seem to be useful for surgical planning and provide us with more tools to perform precision surgeries. Source of Funding: N/A © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e425 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Patricio Garcia More articles by this author Jorge Abril More articles by this author Tomas Carminatti More articles by this author Angelica Castillo More articles by this author Sebastian Tirapegui More articles by this author Alberto Jurado More articles by this author Expand All Advertisement PDF downloadLoading ...

PD43-06 FULLY AUTOMATED AI-GENERATED MODELS PREDICT POST-OPERATIVE GLOMERULAR FILTRATION RATE AFTER RENAL SURGERY WITH SIMILAR ACCURACY TO A VALIDATED CLINICAL MODEL.

You have accessJournal of UrologyCME1 Apr 2023PD43-06 FULLY AUTOMATED AI-GENERATED MODELS PREDICT POST-OPERATIVE GLOMERULAR FILTRATION RATE AFTER RENAL SURGERY WITH SIMILAR ACCURACY TO A VALIDATED CLINICAL MODEL. Nour Abdallah, Tarik Benidir, Nicholas Heller, Andrew Wood, Fabian Isensee, Resha Tejpaul, Chalairat Suk-Ouichai, Nityam Rathi, Diego Aguilar Palacios, Alex You, Erick Remer, Jihad Kaouk, Samuel Haywood, Venkatesh Kirshnamurthi, Steven Campbell, Nikolaos Papanikolopoulos, and Christopher Weight Nour AbdallahNour Abdallah More articles by this author , Tarik BenidirTarik Benidir More articles by this author , Nicholas HellerNicholas Heller More articles by this author , Andrew WoodAndrew Wood More articles by this author , Fabian IsenseeFabian Isensee More articles by this author , Resha TejpaulResha Tejpaul More articles by this author , Chalairat Suk-OuichaiChalairat Suk-Ouichai More articles by this author , Nityam RathiNityam Rathi More articles by this author , Diego Aguilar PalaciosDiego Aguilar Palacios More articles by this author , Alex YouAlex You More articles by this author , Erick RemerErick Remer More articles by this author , Jihad KaoukJihad Kaouk More articles by this author , Samuel HaywoodSamuel Haywood More articles by this author , Venkatesh KirshnamurthiVenkatesh Kirshnamurthi More articles by this author , Steven CampbellSteven Campbell More articles by this author , Nikolaos PapanikolopoulosNikolaos Papanikolopoulos More articles by this author , and Christopher WeightChristopher Weight More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003353.06AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The American Urologic Association recommends estimating postoperative (postop) glomerular filtration rate (GFR) in patients with renal mass to prioritize partial (PN) over radical nephrectomy (RN) when postop GFR<45 mL/min/1.73m2. Validated models based on clinical equations or renal volumes from hand or semi-automated segmentations are quite accurate but have limited uptake in clinical practice. We aimed to develop an artificial intelligence (AI)-GFR prediction calculated automatically on a preoperative (preop) computed tomography (CT) scan to predict a postop GFR as accurately as a validated clinical model. METHODS: Three hundred patients having PN or RN for renal tumor from the KiTS21 challenge were analyzed. We excluded 7 patients having bilateral tumors. Preop GFR was the closest recorded value, and postop GFR was ≥90 days. Split-renal function (SRF) was determined in a fully automated way from preop CT and our deep learning segmentation model. We programmed the algorithm to estimate postop GFR as 1.24×preop GFR×contralateral SRF for RN and 89% of preop GFR for PN. We compared AI-predicted GFR to a validated clinical model (GFR=35+preop GFR (x0.65)-18 (if RN) -age (x0.25)+3 (if tumor size>7 cm)-2 (if diabetes)). We compared AI and clinical model estimations of GFR to the measured postop GFR using correlation coefficients (R) and compared their ability to predict postop GFR<45 using logistic regression and areas under the curves (AUC). RESULTS: In 293 patients, median age was 60 years ((IQR) 51-68), 40.6% were female, and 62.1% had PN. Median tumor size was 4.2 (2.6-6.1), and 91.8% of the tumors were malignant, of which 35.1% were high-grade, 25.6% high-stage, and 21.8% had necrosis. When comparing measured postop GFR, the correlation coefficients were 0.75 and 0.77 for AI and clinical models, respectively. For the prediction of postop GFR<45, the AI and clinical models performed similarly (AUC 0.89 and 0.9, respectively). CONCLUSIONS: Our study introduces a fully automated prediction of postop GFR based on CT and baseline GFR with comparable predictive accuracy to validated clinical prediction models. These AI-based predictions can be implemented for decision-making without clinical details, clinician time, or measurements needed. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e1120 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Nour Abdallah More articles by this author Tarik Benidir More articles by this author Nicholas Heller More articles by this author Andrew Wood More articles by this author Fabian Isensee More articles by this author Resha Tejpaul More articles by this author Chalairat Suk-Ouichai More articles by this author Nityam Rathi More articles by this author Diego Aguilar Palacios More articles by this author Alex You More articles by this author Erick Remer More articles by this author Jihad Kaouk More articles by this author Samuel Haywood More articles by this author Venkatesh Kirshnamurthi More articles by this author Steven Campbell More articles by this author Nikolaos Papanikolopoulos More articles by this author Christopher Weight More articles by this author Expand All Advertisement PDF downloadLoading ...

Total Iodine Contrast-free Strategy for the Endovascular Management of Abdominal Aortic Aneurysms in Chronic Kidney Disease Patients: A Pilot Study

To retrospectively evaluate the feasibility and effectiveness of the endovascular treatment of patients with abdominal aortic aneurysm and chronic kidney disease (CKD) without the need for using iodinated contrast media throughout the diagnostic, therapeutic, and follow-up pathway. A retrospective review of prospectively collected data concerning 251 consecutive patients presenting an abdominal aortic or aorto-iliac aneurysm who underwent endovascular aneurysm repair (EVAR) from January 2019 to November 2022 at our academic institution was performed in order to identify patients with feasible anatomy with respect to manufacturer's instructions for use and with CKD. Patients whose preoperative workout included duplex ultrasound and plain computed tomography for preprocedural planning were extracted from a dedicated EVAR database. EVAR was performed with the use of carbon dioxide (CO2) as the contrast media of choice, whereas follow-up examinations consisted of either duplex ultrasound, plain computed tomography, or contrast-enhanced ultrasound. Primary endpoints were technical success, perioperative mortality, and early renal function variations. Secondary endpoints were all-type endoleaks and reinterventions, midterm aneurysm-related and kidney-related mortality. Forty-five patients had CKD and were treated electively (45/251, 17.9%). Of them, 17 patients were managed with a total iodinated contrast media-free strategy and constituted the object of the present study (17/45, 37.8%; 17/251, 6.8%). In 7 cases, an adjunctive planned procedure was performed (7/17, 41.2%). No intraoperative bail-out procedures were needed. This extracted cohort of patients presented similar mean preoperative and postoperative (at discharge) glomerular filtration rate values, 28.14 (SD 13.09; median 28.06, interquartile range (IQR) 20.25) ml/min/1.73m2 and 29.33 (SD 14.61; median 27.35, IQR 22) ml/min/1.73m2, respectively (P=0.210). Mean follow-up was 16.4months (SD 11.89; median 18, IQR 23). During follow-up, no graft-related complications occurred in terms of either thrombosis, type I or III endoleaks, aneurysm rupture, or conversion. The mean glomerular filtration rate at follow-up was 30.39ml/min/1.73m2 (SD 14.45; median 30.75, IQR 21.93), with no significant worsening in comparison with preoperative and postoperative values (P=0.327 and P=0.856 respectively). No aneurysm- or kidney-related deaths occurred during follow-up. Our initial experience shows that total iodine contrast-free abdominal aortic aneurysm endovascular management in patients with CKD may be feasible and safe. Such an approach seems to guarantee the preservation of residual kidney function without increasing the risks of aneurysm-related complications in the early and midterm postoperative periods, and it could be considered even in the case of complex endovascular procedures.

Accuracy of fully automated, AI-generated models compared with validated clinical model to predict post-operative glomerular filtration rate after renal surgery.

693 Background: The American Urologic Association (AUA) recommends estimation of the postoperative glomerular filtration rate (GFR) in patients with a renal mass to help decide between partial nephrectomy (PN) or radical nephrectomy (RN). If postoperative GFR&lt;45 mL/min/1.73m2, a PN should be prioritized. Most existing methods to predict postoperative GFR are rarely implemented in the clinical setting due to complexity. Previously validated models based on clinical equations or kidney volumes from hand-segmented or semi-automated segmentations are quite accurate but have seen limited uptake in clinical practice. We hypothesize that we could develop an artificial intelligence (AI)-GFR prediction that would be calculated automatically on a preoperative computed tomography (CT) scan and predict a postoperative GFR as accurately as a validated clinical model. Methods: 300 patients undergoing PN or RN for renal tumor from the 2021Kidney and Kidney Tumor Segmentation Challenge(KiTS21) were analyzed. We excluded 7 patients having bilateral tumors. Preoperative GFR was the closest recorded value preoperatively and postoperative GFR≥90 days postoperatively. Split-renal-function (SRF) was determined in a fully automated way from preoperative imaging and our previously developed deep learning segmentation model. We programmed the algorithm to estimate postoperative GFR as 1.24×preoperative GFR×contralateral SRF for RN; and as 89% of the preoperative GFR for PN. We compared AI-predicted GFR to a validated clinical model (GFR=35+preoperative GFR(x0.65)-18(if radical nephrectomy)-age(x0.25)+3(if tumor size &gt;7 cm)-2 (if diabetes)). We compared the AI and clinical model estimations of GFR to the measured postoperative GFR using correlation coefficients (R) and compared the ability of AI models to predict a postoperative GFR&lt;45 using logistic regression and AUCs. Results: In 293 patients, the median age was 60 years ((IQR) 51-68), 40.6% were female, and 62.1% had PN. The median tumor size was 4.2 (2.6-6.1), and 91.8% of the tumors were malignant, of which 35.1% were high-grade, 25.6% were high-stage, and 21.8% had necrosis. The median R.E.N.A.L. nephrometry score was 8 (7-9). When comparing measured postoperative GFR, the correlation coefficients were 0.75 and 0.77 for the AI model and clinical models, respectively. For the prediction of a postoperative GFR&lt; 45 ml/min/1.73m2, the AI and clinical models performed similarly (AUC of 0.89 and 0.9, respectively). Conclusions: Our study demonstrates the feasibility of a fully automated prediction of postoperative GFR based on CT imaging and baseline GFR with comparable predictive accuracy to existing validated clinical prediction models. These AI-generated predictions can be implemented for decision-making, with no clinical details, clinician time, or measurements needed.

Comparison of the efficacy of robotic-assisted retroperitoneal laparoscopy and traditional retroperitoneal laparoscopy in partial nephrectomy among patients with renal tumors: A retrospective cohort study.

The efficacy of robotic-assisted retroperitoneal laparoscopy (RARL) and traditional retroperitoneal laparoscopy (TRL) in patients undergoing partial nephrectomy for treatment of a renal tumor were compared in this study. The retrospective study reviewed patients with renal tumors who underwent partial nephrectomy in our hospital between January 2020 and February 2022. According to different surgical methods, the patients were enrolled into the RARL (experimental group, n=65) or the TRL (control group, n=63) partial nephrectomy group. One hundred twenty-eight patients were reviewed. The number of patients with collecting system injuries in the experimental group (19 cases) was significantly less than in the control group (32 cases; p<0.05). The operative time (115.7±48.2 min vs. 143.1±25.5 min) and heat ischemia time (18.7±4.9 min vs. 26.4±5.2 min) were significantly shorter in the experimental group than in the control group. The intraoperative blood loss (35.4±13.2 mL vs. 96.1±34.3 mL) and postoperative drainage volume (55.9±26.4 mL vs. 75.2±32.6 mL) were significantly less in the experimental group than in the control group (p<0.05). The change in postoperative glomerular filtration rate decrease in the experimental group was significantly lower than that in the control group (p<0.05). The change level in postoperative creatinine increase in the experimental group were significantly lower than those in the control group (p<0.05). There were no considerable differences in other clinical indicators or follow-up results between the two groups. RARL was superior to TRL for renal tumor treatment with respect to operative time, intraoperative blood loss, warm ischemia time, and postoperative renal function recovery.

Continuous Infusion of Iohexol to Monitor Perioperative Glomerular Filtration Rate.

Continuous monitoring of the glomerular filtration rate (GFR) in the perioperative setting could provide valuable information about acute kidney injury risk for both clinical and research purposes. This pilot study aimed to demonstrate that GFR measurement by a continuous 72 hrs iohexol infusion in patients undergoing colorectal cancer surgery is feasible. Four patients undergoing robot-assisted colorectal cancer surgery were recruited from elective surgery listings. GFR was determined preoperatively by the single-sample iohexol clearance method, and postoperatively at timed intervals by a continuous iohexol infusion for 72 hrs. Plasma concentrations of creatinine and cystatin C were measured concurrently. GFR was calculated as (iohexol infusion rate (mg/min))/(plasma iohexol concentration (mg/mL)). The association of the three different filtration markers and GFR with time were analysed in generalized additive mixed models. The continuous infusion of iohexol was established in all four patients and maintained throughout the study period without interfering with ordinary postoperative care. Postoperative GFR at 2 hours were elevated compared to the preoperative measurements for patients 1, 2, and 3, but not for patient 4. Whereas patients 1, 2, and 3 had u-shaped postoperative mGFR curves, patient 4 demonstrated a linear increase in mGFR with time. We conclude that obtaining continuous measurements of GFR in the postoperative setting is feasible and can detect variations in GFR. The method can be used as a tool to track perioperative changes in renal function.

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 ...

Goal-Directed Fluid Therapy Does Not Have an Impact on Renal Outcomes in an Enhanced Recovery Program

BackgroundGoal-directed fluid therapy (GDFT) has been proposed as a cornerstone for enhanced recovery after surgery (ERAS) programs, particularly among high-risk patients undergoing high-risk surgery. However, because of the increased advocacy of euvolemia before surgery, the utility of GDFT in the context of ERAS is being questioned. Our primary objective was to determine whether GDFT has any impact on daily postoperative renal outcomes of high-risk patients undergoing thoracic surgery in an ERAS program. MethodsAll patients included in this study were at high risk with a baseline glomerular filtration rate (GFR) below 90 mL/min per 1.73 m2 and assigned to American Society of Anesthesiologists class III or class IV. Patients were categorized into 2 groups according to the intraoperative use of GDFT. The groups were matched in a 1:1 fashion using propensity scores. Our renal outcomes included changes in daily GFRs from the postanesthesia care unit through postoperative day 5. ResultsIn total, 451 matched pairs were included in this analysis. Both groups had similar demographic and clinical characteristics. Patients treated with GDFT received more ephedrine (5 [0-15] mg vs 0 [0-15] mg; P = .03) and less volume of fluids (1163 ± 484 mL vs 1246 ± 626 mL; P = .03) compared with those in the standard group. The incidence of acute kidney injury was similar in both groups (5.1% in the GDFT group vs 7.1% in the non-GDFT group; P = .57). Mixed effect analysis showed no significant differences in the trajectory of postoperative GFRs between groups (P = .59). ConclusionsGDFT does not have an impact on postoperative renal function compared with standard of care among high-risk patients in an ERAS program for thoracic pulmonary surgery.

Effect of Papaverine on Renal Artery Blood Flow during Robot-Assisted Partial Nephrectomy: A Randomized Controlled Study.

During robot-assisted partial nephrectomy (RAPN), renal artery clamping is necessary to optimize the surgical field. However, renal artery clamping can induce renal blood flow reduction and postoperative renal dysfunction. Papaverine is used as a potent vasodilator agent. We determined if periarterial administration of papaverine after renal artery clamping improved intraoperative renal artery blood flow and early postoperative glomerular filtration rate (GFR) compared with placebo in RAPN. In this randomized controlled trial, 96 patients who underwent RAPN were enrolled between November 2019 and December 2020. Patients were administered periarterial normal saline as a placebo (placebo group) or papaverine (papaverine group) just after renal artery declamping. The primary outcome was renal artery blood flow by Doppler ultrasound 2 min after periarterial administration of papaverine or placebo after renal artery declamping. The secondary outcome was GFR estimated by renal scan 3 months after RAPN. Renal artery blood flow and GFR were significantly higher in the papaverine group than in the placebo group (538.0 [376.6-760.0] mL/min versus 338.8 [205.8-603.4] mL/min, P = 0.002 and 93.5 ± 17.1 mL/min/1.73 m2 versus 85.9 ± 15.8 mL/min/1.73 m2, P = 0.033, respectively). Periarterial papaverine administration increased intraoperative renal artery blood flow and early postoperative GFR in RAPN, suggesting that papaverine administration has beneficial effects on renal perfusion after renal artery clamping and could be a valuable option for improving renal function after RAPN.

Cholecalciferol pretreatment ameliorates ischemia/reperfusion-induced acute kidney injury through inhibiting ROS production, NF-κB pathway and pyroptosis

Acute kidney injury (AKI) is a common complication in patients with potentially life-threatening diseases, and it is also usually associated with unacceptable morbidity and mortality rates. Therefore, new and efficient therapies are urgently required to relieve AKI. It is well known that, reactive oxygen species (ROS), the NF-κB signaling pathways and pyroptosis are involved in AKI induced by ischemia/reperfusion (I/R). The present study seeks to further confirm the internal relationship between vitamin D deficiency and I/R-induced AKI in patients, and to explore the underlying mechanisms of ROS, NF-κB signaling pathways and pyroptosis in the renal ischemia-reperfusion injury, as well as investigating the protective role of cholecalciferol. Patients with vitamin D deficiency show worse renal function reflected by postoperative glomerular filtration rate (GFR) and more release of proinflammatory cytokine IL-1β and IL-18. Renal cell injury and renal dysfunction induced by I/R surgery were attenuated in the ICR mice administered with cholecalciferol. Cholecalciferol reduced ROS production, suppressed activated NF-κB signaling, and inhibited gasdermin D (GSDMD, a pyroptosis execution protein)-mediated pyroptosis. Cholecalciferol therefore has potential, as a clinical drug, to protect renal function in I/R-induced AKI through reducing ROS production, NF-κB activation and GSDMD-mediated pyroptosis.