Preoperative Aspects And Dimensions Used For An Anatomical Classification Research Articles

Nephrometry Scoring Systems for Nephron Sparing Surgery in Children.

The surgical decision to attempt nephron-sparing surgery (NSS) in children with renal tumors can be difficult. In adults, nephrometric tools are used for decision-making. More than 90% of low-complexity tumors are eligible for NSS, and high-complexity tumors often require total nephrectomy. We retrospectively applied those nephrometric tools [Radius, Exophytic, Nearness to the sinus or collecting system, Anterior/posterior, Location relative to polar lines (RENAL), Preoperative Aspects and Dimensions Used for an Anatomical classification (PADUA), and Renal Tumor Invasion Index (RTII) scoring systems] to the preoperative imaging of children operated for renal tumors in our institution from 2015 to 2019 and correlated them with the type of surgery. The scores were assessed by 2 independent surgeons and 1 radiologist. Forty-four tumors were removed, including 16 NSS, 38 after neo-adjuvant chemotherapy, and 6 upfront surgeries, in 30 children. More than 50% of patients in the low and medium-risk population for RENAL, PADUA, and RTII scores, and ~15% in the high-complexity categories underwent NSS. Tumors removed through NSS were significantly less complex according to each score. Interobserver reliability was good for 3 scores. The application of the RENAL, PADUA, and RTII was able to accurately classify most of the pediatric tumors, according to their complexity. These scores could help increase the indications of NSS in renal tumor surgery.

Evaluation of the Existing Electrophysiological Severity Classifications in Carpal Tunnel Syndrome

Electrophysiological examination is important for the diagnosis and evaluation of nerve function in carpal tunnel syndrome (CTS). Electrophysiological severity classifications of CTS using a nerve conduction study (NCS) have been reported, and there are many reports on the relationship between severity classifications and clinical symptoms. The existing electrophysiological severity classifications have several problems, such as cases that do not fit into a classification and unclear reasons for the boundary value. The purpose of this study was to clarify the relationship between sensory nerve conduction velocity (SCV) and distal motor latency (DML) and to evaluate whether the existing severity classification method is appropriate. We created a scatter diagram between SCV and DML for our NCSs and found a negative correlation between SCV and DML (correlation coefficient, −0.786). When we applied our NCSs to the existing classifications (Padua and Bland classifications), there were many unclassifiable cases (15.2%; Padua classification), and the number of Grade 3 cases was significantly higher than that of Grade 2 or 4 cases (Bland classification). Our large dataset revealed a strong negative correlation between SCV and DML, indicating that the existing severity classifications do not always accurately reflect the severity of the disease.

External validation of SPARE nephrometery score in predicting overall complications, trifecta and pentafecta outcomes following robot-assisted partial nephrectomy.

There is an ongoing need and search for a simple yet accurate nephrometry scoring system for predicting the postoperative outcomes after partial nephrectomy (PN). Simplified PADUA Renal (SPARE) Nephrometry Scoring System, a simplified version of Preoperative Aspects and Dimensions Used for an Anatomical Classification (PADUA) has been proposed as a predictor of postoperative complications following PN recently. However, this score has never been externally validated and assessed as a predictor of trifecta and pentafecta outcomes of PN. In the current study, we applied the SPARE scoring system to our robot-assisted PN cohort (RAPN). Prospectively maintained data of patients, who underwent RAPN from November 2014 to December 2018, was abstracted. Imaging was analyzed to calculate SPARE and RENAL nephrometry scores (RNS) by two urologists, independently. SPARE was compared with complications, trifecta outcomes, pentafecta outcomes, and RENAL nephrometry scoring (RNS). Data of 201 RAPN patients were analyzed. The mean SPARE score was 3 (range 0-11). One hundred thirteen patients were classified as low risk, 64 as intermediate risk, and 24 as high risks. On multivariate analysis SPARE score alone predicted complications (OR=1.37, P=0.014) and trifecta outcomes (OR=0.75, P=0.000) while age (OR=0.96, P=0.042), preoperative eGFR (OR=0.97, P=0.001) and SPARE scores (OR=0.81, P=0.016) were predictors for pentafecta outcomes. Receiver operated curve (ROC) analysis between SPARE and RNS in predicting the complications; trifecta and pentafecta outcomes had a comparable area under the curve. Our study validates the SPARE nephrometry scoring system in predicting postoperative complications, trifecta, and pentafecta outcomes in a RAPN cohort. The predictive accuracy of SPARE is similar to RNS.

Diagnosis and Severity Evaluation of Ulnar Neuropathy at the Elbow by Ultrasonography: A Case-Control Study.

Traditional diagnostic techniques such as clinical examination and electrodiagnosis are less sensitive in diagnosing ulnar neuropathy at the elbow (UNE). Ultrasonography (USG) is increasingly being used to diagnose UNE. However, clinical applicability is limited by the lack of uniformity in the previous studies. Therefore, we aimed to study in the Indian patients the diagnostic utility of the ulnar nerve cross-sectional area (CSA) and a novel parameter-entrapment index (EI) in UNE measured by USG and to find if both these parameters correlate with the electrodiagnostic severity. This retrospective casecontrol study included 28 patients (36 nerves) of UNE and 12 (24 nerves) age- and gender-matched healthy controls. Electrodiagnostic severity was graded using the Padua classification. USG was performed in both groups, and CSA was measured at the medial epicondyle (ME) and 5 cm proximally and distally. EI was calculated by multiplying the ratio of CSA above ME over CSA at ME by 100. Best cutoffs were derived by the receiver operating characteristic curve analysis. UNE group had significantly higher CSA at all three locations and lower EI than the control group. CSA at ME ≥9.7 mm2 and EI ≤61.5 has sensitivity and specificity of 88.9%/87.5% and 72.2%/79.2%, respectively. There was no significant difference in CSA and EI between nonsevere and severe UNE groups. CSA at ME and EI have good sensitivity and specificity in diagnosing UNE. However, they cannot differentiate nonsevere from severe UNE.

Is There an Association between the RENAL and PADUA Nephrometry Scores and the Trifecta and Pentafecta Achievement?

Background: RENAL and PADUA scoring systems have been designed and validated as a method to assess the complexity of renal masses and predict the risk of perioperative complications. We aimed to evaluate if there is an association between RENAL and PADUA nephrometry scores with the Trifecta and Pentafecta achievement. Materials and Methods: We retrospectively analysed the data from 102 patients with renal cell carcinoma who underwent partial nephrectomy from January 2011 to October 2018 at our institution. Radiological characteristics of the renal masses were scored according to the RENAL and PADUA classification. Trifecta and Pentafecta achievement were collected. We performed a descriptive analysis and used de χ2 test to evaluate the relationship between PADUA and RENAL scores and Trifecta and Pentafecta achievement. Result: Among 102 patients, the median tumor size was 2.7 cm (IQR 0.8-7.5), the median RENAL score was 7 (IQR 4-11) and PADUA score 8 (IQR 6-14). The overall rate of postoperative complications was 21.6% (n=22). The rates of Trifecta and Pentafecta achievement were 50% (n=51/102) and 46.1% (n=47/102), respectively. Trifecta and Pentafecta achievement were higher when the PADUA score was ≤10 (OR 3.62; IC95% (1.08-12.11); p=0.0317) and (OR 4.98; IC95% (1.32-18.7); p=0.0175), respectively. Likewise, Trifecta and Pentafecta achievement were higher in patients with RENAL score ≤ 8 (OR 4.09; IC95% (1.46-11.42); p=0.0072) and (OR 4.92; IC95% (1.66-14.51); p=0.0039), respectively. Conclusion: There is an association between the RENAL and PADUA nephrometry scores and the Trifecta and Pentafecta achievement.

Simplified PADUA Renal (SPARE) Nephrometry Scoring System: External Validation, Interobserver Variability, and Comparison with RENAL and PADUA in a Single-center Robotic Partial Nephrectomy Series

BackgroundThe RENAL (radius [R], exophytic/endophytic [E], nearness to collecting system/sinus [N], anterior/posterior [A], and location relative to polar lines [L]) and the PADUA (preoperative aspects and dimensions used for an anatomical classification) scores help in quantifying tumor complexity. However, nephrometry scoring systems have low interobserver variability. To simplify and improve score reproducibility, a new Simplified PADUA Renal (SPARE) scoring system was introduced. ObjectiveTo externally validate the SPARE nephrometry scoring system and to determine its interobserver variability. Design, setting, and participantsA total of 202 patients were included in the analysis. We performed a retrospective analysis of robot-assisted partial nephrectomy (RAPN) cases for a single renal mass performed at a single academic institution during the period 2008–2018. For each renal mass, PADUA, RENAL, and SPARE nephrometry scores were calculated. Outcome measurements and statistical analysisThree urology residents (URs), two urology attendings (UAs), two radiology residents (RRs), and one radiology attending (RA) retrospectively reviewed computed tomography scans blinded to clinical outcomes. The accuracy of the SPARE nephrometry score in the prediction of any complication (Clavien grade ≥1) was compared with other scoring systems in a univariable and a multivariate fashion. The area under the curve (AUC) and kappa statistics were used to assess interobserver variability of the SPARE score. Results and limitationsThe SPARE score was not inferior to the PADUA and RENAL scores (AUC 0.61, 0.59, and 0.57, respectively, p = 0.43). Patients with intermediate to high SPARE scores had longer operative time (158 vs 135 min, p = 0.10) and a higher rate of complications (28% vs 14%, p = 0.012). Univariable analysis predicting overall complications showed that RRs performed slightly better than URs and UAs using the SPARE score. Interobserver agreement was 84% between an RA and an RR (kappa 0.42), 85% between an RA and a UA (kappa 0.39), and 85% between an RA and a UR (kappa 0.45). ConclusionsThese findings confirm that the SPARE nephrometry scoring system is a reproducible and easy tool offering overall fair interobserver agreement regardless of years of training or type of practice, while maintaining the predictive capabilities of more established nephrometry scores. Patient summaryIn this study, a novel and simple classification system was assessed using a sample of cases from our institution to define surgical complexity renal masses detected on radiological imaging. Our findings suggest that this tool can be useful in clinical practice to facilitate the characterization of renal masses and predict the complications of surgical treatment.

The Simplified PADUA REnal (SPARE) nephrometry system: a novel classification of parenchymal renal tumours suitable for partial nephrectomy.

To simplify the original Preoperative Aspects and Dimensions Used for an Anatomical (PADUA) classification of renal tumours, generating a new system able to predict equally or better the risk of overall complications in patients undergoing partial nephrectomy (PN); and to test if the addition of the contact surface area (CSA) parameter improves the accuracy of the original PADUA and new Simplified PADUA REnal (SPARE) nephrometry classification systems. We analysed the clinical records of 531 patients who underwent PN (open, laparoscopic and robot-assisted) for renal tumours at five tertiary academic referral centres from January 2014 to December 2016. The ability of each variable included in the PADUA classification to predict overall complications was tested using binary logistic regression analysis. The variables that were not statistically significant were excluded from the SPARE classification. In addition to the original PADUA and SPARE systems, another two models were generated adding tumour CSA. Receiver operating characteristic curve analysis was used to compare the ability of the four different models to predict overall complications. Binary logistic regression was used to perform both univariable and multivariable analyses looking for predictors of postoperative complications. Linear regression analysis was used to identify independent predictors of absolute change in estimated glomerular filtration rate (eGFR; ACE). The SPARE nephrometry score system including: (i) rim location, (ii) renal sinus involvement, (iii) exophytic rate, and (iv) tumour dimension; showed equal performance in comparison with the original PADUA score (area under the curve [AUC] 0.657 vs 0.664). Adding tumour CSA to the original PADUA (AUC 0.661) or to the SPARE (AUC 0.658) scores did not increase the accuracy of either system to predict overall complications. The SPARE system (odds ratio 1.2, 95% confidence interval 1.1-1.3) was an independent predictor of postoperative overall complications. Age (P < 0.001), body mass index (P < 0.001), Charlson Comorbidity Index (P = 0.02), preoperative eGFR (P < 0.001), and tumour CSA (P = 0.005) were independent predictors of ACE. Limitations include the retrospective design and the lack of central imaging review. The new SPARE score is comprised of only four variables instead of the original six and its accuracy to predict overall complications is similar to that of the original PADUA score. Addition of tumour CSA was not associated with an increase in prognostic accuracy. The SPARE system could replace the original PADUA score to evaluate the complexity of tumours suitable for PN.

245P - Comparison of partial nephrectomy and percutaneous radiofrequency ablation for small renal mass in the manner of PADUA classification

245P - Comparison of partial nephrectomy and percutaneous radiofrequency ablation for small renal mass in the manner of PADUA classification

Long-term oncologic and functional outcomes after robot-assisted partial nephrectomy in elderly patients.

The aim of this study was to assess the long-term oncologic and functional outcomes in elderly patients having undergone robot-assisted partial nephrectomy (RAPN) for renal cancer (RC). Sixty-one patients out of 323 who underwent RAPN for localized RC between July 2009 and March 2016 in our high-volume robotic surgery center (>800 procedures/year), had 70 years or more. Inclusion criteria of the study were age ≥70 years; pathological confirmed RCC and ASA Score ≤3. All patients were stratified according to PADUA classification system in three groups: <7 points, 8-9 points, >10 points. Trifecta was defined as a warm ischemia time (WIT) less then 25 min, negative surgical margins and no perioperative complications. A total of 52 patients were included; median follow-up was 47 months. Median age was 74 yrs. (IQR 72-76.5). Complication rate was 15.4%. Trifecta failure was associated to PADUA Score (P=0.02), and tumor diameter (P=0.04). Renal function was altered in 10 (19.2%) patients before surgery and at last follow-up in 11 (21.1%) patients (CKD stage>2) The DFS, OS and CSS were 89.33%, 90.06% and 94.4%, respectively. In a high-volume center, robot-assisted approach is feasible and safe in surgical fit elderly patients with good long-term oncologic outcomes.

Value of oxyneurography, based on near infrared spectroscopy, in the diagnosis of carpal tunnel syndrome in comparison to provocative clinical diagnostic tests and nerve conduction studies

ObjectiveEvaluation of the diagnostic utility of the oxyneurography (ONG) in diagnosing carpal tunnel syndrome (CTS). MethodsONG examination of the median nerve was performed in 260 patients. The results were compared with nerve conduction studies and clinical provocative tests. ResultsONG index greater than or equal to 62% was found in 95.18% of the patients with no or minimal Nerve Conduction Study (NCS) changes (1–2 according to the Padua classification) but only in 1.69% of the patients with advanced NCS changes (Padua 3–6). The sensitivity and specificity of the ONG study i.e. 95.18% and 98.31%, respectively, were compared with standard clinical tests: Tinel sign (61.45% and 14.69%), Phalen test (34.94% and 45.20%), reverse Phalen test (81.93% and 34.46%) and carpal compression test (91.57% and 72.32%). ConclusionsONG index lower than 62% was indicative of CTS. ONG has higher sensitivity and specificity then other clinical tests and it is an accurate and reliable method for the diagnosis of CTS. SignificanceOxyneurography is a non-invasive, fast and safe study which may play role in the diagnosis of carpal tunnel syndrome.

A study the various clinical and electrophysiological parameters of severity of carpal tunnel syndrome, their correlation with post-operative recovery.

Objective:We aimed to study the various clinical and electrophysiological parameters of severity of carpal tunnel syndrome (CTS) and to see if the severity of CTS affects recovery after surgery.Patients and Methods:A prospective study of 35 patients suffering from CTS. Clinical severity was assessed using visual analogue scale and standard questionnaires such as Levine and Disabilities of Arm, Shoulder and Hand questionnaires. All the patients underwent electrophysiological evaluation to assess electrophysiological severity of CTS. According to modified Padua classification, they were classified into three groups, namely, minimal to mild, moderate and severe to extreme. All patients underwent Carpal tunnel release in our unit. The clinical assessment was repeated 3 months post-operatively.Results:Out of 33 patients, majority (65.7%) of the patients were suffering from moderately severe CTS. The clinical provocative tests were positive in majority of patients. Clinically and statistically significant (P < 0.001) improvement was seen in all clinical severity scores. However, it did not show any statistical correlation with electrophysiological severity of the disease when compared among the groups. There was no association of age, gender of the patient, body mass index, hand dominance, affected side of the patient, results of provocative tests and the presence or absence of thenar muscle atrophy when compared among the three severity groups (P > 0.05).Conclusions:Although pre-operative clinical scores of severity and electrophysiology have a diagnostic role in CTS, they do not correlate with post-operative recovery and in turn fail to predict the extent of post-operative recovery before surgery.

Initial results of selective renal parenchymal clamping with an adjustable kidney clamp in nephron-sparing surgery: an easy way to minimise renal ischaemia.

A renal parenchymal clamp has been used at our centre since March 2012. It is used in position over the kidney to achieve optimal vascular control of a tumour while minimising parenchymal ischaemia. This study aimed to report the feasibility, surgical outcome, and oncological control of a kidney clamp in partial nephrectomy. This study was conducted at a teaching hospital in Hong Kong. Partial nephrectomies performed from January 2009 to March 2015 were reviewed. The tumour characteristics and surgical outcomes of kidney clamp were studied and compared with traditional hilar clamping. A total of 92 patients were identified during the study period. Kidney clamps were used in 20 patients and hilar clamping in 72, with a mean follow-up of 27 and 37 months, respectively. For patients in whom a kidney clamp was applied, all tumours were exophytic to a different extent and the majority (90%) were located at the polar region. The PADUA (preoperative aspects and dimensions used for an anatomical) classification nephrometry score was also lower than those in whom hilar clamping was used (7.07 vs 8.34; P=0.002). The clamp was used in open, laparoscopic, and robot-assisted surgery. Operating time was shorter (207 ± 72 mins vs 306 ± 80 mins; P<0.001) and estimated blood loss was lower (205 ± 191 mL vs 331 ± 275 mL; P=0.045) with kidney clamp. No acute kidney injury occurred. Postoperative renal function was comparable between the two groups. Partial nephrectomy using parenchymal clamping is safe and feasible in selected cases. The postoperative renal function and oncological control were satisfactory.

Computed Tomography Contrast Enhancement Following Renal Cryoablation--Does it Represent Treatment Failure?

For minimal invasive treatment of small renal masses, cryoablation has gained popularity. Treatment success is defined as the absence of contrast enhancement on postoperative imaging of the cryoablated lesion, but contrast enhancement does not necessarily equal treatment failure. This present study investigates the proportion of spontaneous resolutions after initial contrast enhancement in relation to cryoablation. Data were collected from a prospectively maintained clinical database containing all patients treated with primary laparoscopic and percutaneous cryoablation between August 2005 and December 2013. All images were evaluated with regard to preoperative aspects and dimensions used for an anatomical classification (PADUA) score, cryolesion size, contrast enhancement pattern, and tissue density. A total of 107 patients with a biopsy-verified malignant tumor were included in the study. On postoperative imaging, 33 (31%) patients presented with contrast enhancement. Spontaneous resolution was observed in 15 (45%) patients after a mean follow-up time of 14 months. Patients with cryolesions that resolved spontaneously were found to have a less anatomical complex tumor compared to patients with treatment failure (PADUA 7.8 vs 9.5, p < 0.01). A total of seven patients with a PADUA score ≥10 and contrast-enhancing cryolesions were found to have treatment failure. No association was found among body mass index, histology, treatment modality, enhancement pattern, number of applied cryoprobes, and resolution. Postoperative contrast enhancement is commonly observed after cryoablation and a large portion of these lesions often resolves spontaneously, thus not representing treatment failure. In patients with a high preoperative PADUA score and postoperative contrast enhancement of the cryolesion, treatment failure or recurrent disease should be suspected.

Functional Outcome Prediction after Partial Nephrectomy using R.E.N.A.L Nephrometry, PADUA Classification and Centrality Index Score

Functional Outcome Prediction after Partial Nephrectomy using R.E.N.A.L Nephrometry, PADUA Classification and Centrality Index Score

Comparison of partial nephrectomy and percutaneous radiofrequency ablation for small renal masses in the manner of preoperative aspects and dimensions used for an anatomical (padua) classification

Comparison of partial nephrectomy and percutaneous radiofrequency ablation for small renal masses in the manner of preoperative aspects and dimensions used for an anatomical (padua) classification

Novel Hat–Spherical partial nephrectomy for localized kidney cancer treatment

Objective To present a novel Model for partial nephrectomy and evaluate its oncological, functional outcomes and complication risks in the application for localized kidney cancer treatment. Methods Two hundred and ten patients with localized kidney cancer underwent open or laparoscopic Hat–Spherical partial nephrectomy from Mar. 2011 to Dec. 2013, and were included for this retrospective analysis. Of the 210 patients, 145 were males and 65 were females. The age ranged from 25 to 78 (56±12) years. The tumor greatest dimension was ≤4.0 cm in 143 cases (68.1%), 4.1–7.0 cm in 49 cases (23.3%) and >7.0 cm in 18 patients (8.6%). According to PADUA (Preoperative Aspects and Dimensions Used for an Anatomical) classification, 90, 86 and 34 patients were respectively stratified as low– (42.9%), intermediate– (40.9%) and high–risk (16.1%) groups. In contrast to traditional technique, the key points of Hat–Spherical partial nephrectomy were as follows: after clamping, the renal capsule was incised sharply 3–5 mm away from the tumor edge, and the incision plane was wedge–shaped and towards the tumor pseudocapsule. The transition between pseudocapsule and normal renal parenchyma was the ideal surgical plane. When reached, the tumor was bluntly separated from the surrounding parenchyma following the natural plane. When close the bottom or approaching the renal sinus, the tumor was enucleated along the pseudocapsule. The positive surgical margin rate, warm ischemic time, complication rate and the postoperative eGFR decline were evaluated. The criteria, in which the 3 key outcomes of negative cancer margin, minimal renal functional decrease and no urological complications, were applied to evaluate the Hat–Spherical partial nephrectomy technique. Results Ninety–two patients underwent open Hat–Spherical partial nephrectomy. The mean operation time was 120±45 min, the mean warm ischemic time was 15±5 min. The estimated blood loss was 246±188 ml. Twenty–two patients (23.9%) needed renal calyceal repairing. One hundred and eighteen patients underwent laparoscopic Hat–Spherical partial nephrectomy. The mean operation time and warm ischemic time were 145±50 min and 23±7 min, respectively. The mean estimated blood loss was 185±120 ml and 30 patients (25.4%) needed renal calyceal repairing. The rate of positive surgical margin was 0.95% (2/210). A total of 42 patients (20.0%) experienced complications during 30 days postoperatively, including 36 ClavienⅠ–Ⅱ minor complications and 6 cases of Clavien Ⅲ–Ⅳ major complications. There were 6 postoperative bleeding events (2.9%) and 4 urine leakages (1.9%). There was no perioperative death. The median (range) follow–up was 18 (10–38) mon. The mean decrease in postoperative eGFR was 9.8±20.4 ml/(min· 1.73 m2), and 62 patients had a greater than 10% reduction in the actual vs volume predicted postoperative eGFR. Until the last follow–up, there was no local recurrence and distant metastasis. Trifecta outcome was achieved in 85 patients (40.5%). Conclusions The Hat–Spherical partial nephrectomy has three main technical advantages, including safely keeping negative surgical margin, maximal preservation of renal parenchyma and reducing the risk of vessel and renal calyceal injury. The superiority of Hat–Spherical technique over traditional partial nephrectomy needs further validation by prospective comparative clinical trials. Key words: Kidney cancer; Hat–Spherical partial nephrectomy; Transition zone

Critical appraisal of first-generation renal tumor complexity scoring systems: Creation of a second-generation model of tumor complexity

ObjectiveTo investigate whether a combination of variables from each nephrometry system improves performance. There are 3 first-generation systems that quantify tumor complexity: R.E.N.A.L. nephrometry score (RNS), preoperative aspects and dimensions used for an anatomical (PADUA) classification (PC), and centrality index (CI). Although each has been subjected to validation and comparative analysis, to our knowledge, no work has been done to combine variables from each method to optimize their performance. Patients and methodsScores were assigned to each of 276 patients undergoing partial nephrectomy (PN) or radical nephrectomy (RN). Individual components of all 3 systems were evaluated in multivariable logistic regression analysis of surgery type (PN vs. RN) and combined into a “second-generation model.” ResultsIn multivariable analysis, each scoring system was a significant predictor of PN vs. RN (P<0.0001). Of the first-generation systems, CI was most highly correlated with surgery type (area under the curve [AUC] = 0.91), followed by RNS (AUC = 0.90) and PC (AUC = 0.88). Each individual component of these scoring systems was also a predictor of surgery type (P<0.0001). In a multivariable model incorporating each component individually, 4 were independent predictors of surgery type (each P<0.005): tumor size (RNS and PC), nearness to the collecting system (RNS), location along the lateral rim (PC), and centrality (CI). A novel model in which these 4 variables were rescaled outperformed each first-generation system (AUC = 0.91). ConclusionsOptimization of first-generation models of renal tumor complexity results in a novel scoring system, which strongly predicts surgery type. This second-generation model should aid comprehension, but future work is still needed to establish the most clinically useful model.

The association between the anatomical features of renal tumours and the functional outcomes of robot-assisted partial nephrectomy.

We evaluated the the association between PADUA scores and postoperative renal function (after robot-assisted partial nephrectomy [RAPN]) and between PADUA scores and warm ischemic time (during RAPN). We reviewed the clinical records of 106 patients who underwent RAPN for a single localized renal tumour between April 2009 and June 2012. Postoperative renal function was evaluated using estimated glomerular filtration rate (eGFR) in 85 patients who were followed for at least 6 months. PADUA scores for renal tumours were calculated using contrast-enhanced computed tomography images, if needed, along with magnetic resonance images in some cases. A PADUA score ≥10 and WIT ≥30 minutes were observed in 18 (17.0%) and 51 (48.1%) cases, respectively. PADUA scores were significantly correlated with WIT (p = 0.019) and percent change in eGFR at 6 months postoperatively (p = 0.005). PADUA score (continuous variable, odds ratio [OR] 1.694, p = 0.007) and the high-risk group (PADUA score ≥10) (OR 5.429; p = 0.020) were significantly associated with a WIT of ≥30 minutes by multivariate analysis. A 1-point increase in the PADUA score was associated with an eGFR decrease of >20% at 6 months after RAPN (OR 1.799; p = 0.076). In addition, a PADUA score ≥10, or high risk, (OR 13.965; p = 0.003) was an independent predictor of an eGFR decrease of >20% at 6 months after RAPN. The PADUA classification can reliably predict WIT and postoperative renal functional outcome after RAPN. Furthermore, the study suggests that anatomical aspects of renal tumours are associated with functional outcome after RAPN.

Renal tumour anatomical characteristics and functional outcome after partial nephrectomy

Objective. Anatomical features of renal tumours may be useful in predicting glomerular filtration rate (GFR) after partial nephrectomy. In this study, anatomical classification systems (ACSs) were compared to predict changes in renal function after surgery. Materials and methods. A group of 294 patients with T1 renal tumours receiving partial nephrectomy between January 2006 and June 2013 were identified from the institutional kidney tumour database. Preoperative images from computed tomography or magnetic resonance imaging were reviewed to assess diameter, PADUA (preoperative aspects and dimensions used for an anatomical) classification score, RENAL (radius, exophytic/endophytic properties of the tumour, nearness of tumour deepest portion to the collecting system or sinus, anterior/posterior descriptor and location relative to polar lines) nephrometry score, centrality index (C index) and renal tumour invasion index (RTII). GFR was estimated using the Modification of Diet in Renal Disease equation preoperatively and 3 months after operation. Linear and logistic regression were applied as statistical methods. Results. Mean tumour diameter was 3.0 ± 2.2 cm (range 1.0–7.0 cm). GFR was 85 ± 22 ml/min/1.73 m² before the operation and 77 ± 21 ml/min/1.73 m² (–8% change) 3 months after the operation. In univariate linear regression, the percentage change in GFR was weakly but statistically significantly associated with surgical approach (p = 0.04), indication for nephron sparing (p = 0.02), preoperative GFR (p < 0.001), PADUA (p = 0.02), RENAL (p = 0.01) and RTII (p = 0.003). In multivariate logistic regression analysis among patients with tumours 3 cm or larger, PADUA (odds ratio 1.55, p = 0.021) and RTII (odds ratio 3.87, p = 0.037) predicted at least a 20% reduction in GFR. Conclusions. Renal tumour ACSs may be clinically useful in predicting changes in renal function after partial nephrectomy in patients with larger tumours. The performance of RTII is equal to that of other ACSs in predicting changes in GFR.

The RENAL Nephrometry Score and the PADUA Classification for the Prediction of Perioperative Outcomes in Patients Receiving Nephron-Sparing Surgery: Feasible Tools to Predict Intraoperative Conversion to Nephrectomy

Objective: To evaluate the potential of the RENAL nephrometry score and the PADUA classification in the prediction of perioperative outcomes represented by intraoperative conversion to nephrectomy in patients with renal tumors for which nephron-sparing surgery (NSS) was attempted. Methods: Recent 100 open NSSs attempted for cT1 renal tumors at a single institution were studied retrospectively. Results: With the RENAL, the operation time and ischemia time were longer in the high complexity group (p = 0.01 and p = 0.03, respectively), and blood loss was seemingly greater in this group (394 vs. 220 and 167 ml, p = 0.09). Conversion to nephrectomy was more frequent in the high complexity (4 procedures, 33.3%) than in the low (0%) and moderate (1 procedures, 1.5%) groups (p < 0.01). Regarding the PADUA, the operation time, blood loss and ischemia time increased according to the complexity (p = 0.04, p = 0.02, and p = 0.02, respectively). Conversion to nephrectomy was more frequent in the high complexity (4 procedures, 22.2%) than in the low (0%) and moderate (1 procedure, 1.8%) groups (p < 0.01). In patients with achieved NSS, postoperative estimated glomerular filtration rate was more impaired in the high complexity group in the PADUA (p = 0.02), although not significant in the RENAL (p = 0.11). Conclusions: Both the RENAL and PADUA are useful in the prediction of conversion to nephrectomy in addition to NSS-associated perioperative outcomes.