Renal Surgery Research Articles

Nephrolithiasis-associated Bacteriuria: Pre-operative Evaluation of Patients Candidate for Intervention at Faghihi and Namazee Hospitals, Shiraz Universities of Medical Sciences, 2020-2021

Background and Objective: Patients who have nephrolithiasis and are candidates for operation may have symptomatic or asymptomatic bacteriuria, which should be treated before any surgical intervention. We evaluated our patients for the prevalence of bacteriuria before surgical intervention. Materials and Methods: Between March 2020 and March 2022, a total of 832 patients (489 men and 343 women) with a mean age of 38.4 years, who were candidates for renal stone surgery, were evaluated by tests, including complete blood count, urine analysis, and preoperative culture. In this study, we recorded the bacteriuria (symptomatic or asymptomatic). Results: Of 832 patients, 594 had the first episode of stone formation and 238 had recurrent diseases. Of these, 784 patients were scheduled for percutaneous nephrolithotomy and 48 patients for open nephrolithotomy. Overall, in the preoperative urine analysis test, 56 cases of bacteriuria were reported, of which 22 cases had positive urine cultures. Of the positive culture cases, 14 were recurrent and 8 were patients who had kidney stones for the first time. The most common microorganism was Escherichia coli (n=15), followed by Klebsiella (n=4), Proteus (n=2), and Pseudomonas (n=1). Only 8 of these patients had symptoms and the rest were asymptomatic. All of these patients received a course of oral antibiotics before the operation. Conclusion: Bacteriuria is a common finding in patients with nephrolithiasis that seems to be more common in recurrent diseases; therefore, urine culture and appropriate treatment are mandatory before any intervention to prevent serious complications, such as infection, sepsis, and mortality.

Pattern of urinary tract and surgical site infection in allograft renal recipient during early postoperative period

A kidney transplant (KT) offers a significant survival benefit and is the only curative treatment for patients with ESRD. Infectious complications are still a leading cause of morbidity and death among transplant patients. This study aimed to assess the organisms and risk factors responsible for urinary tract and surgical site infection in allograft live-related renal transplant recipients during the early post-transplant period. This observational follow-up study was conducted among 20 purposively selected patients who underwent renal allograft transplant surgery from July 2019 to December 2020 in the Department of Urology, BSMMU, Dhaka. Patients with a history of renal transplant recipients or congenital renal anomalies and any urological malignancy were excluded from the study. After kidney transplant, UTI developed in 6 (30%) renal transplant recipients where all were complicated types and occurred between 10 to 14 days postoperatively. UTI was caused by E. coli in 3 (15%) patients, while Klebsiella and Enterococci were causative organisms for 1 (5%) and 2 (10.0%) patients, respectively. SSI developed in 3 (15%) renal transplant recipients where two were superficial, and one was deep. SSI occurred between 5-8 days postoperatively. SSI was caused by S. aureus in 2 (10%) patients and Pseudomonas in 1 (5%) patient. UTI was significantly more in older patients and the patients with a longer duration of catheterization. Older patients and overweight patients had significantly higher rates of SSI. In total, 33% of the recipient during the early hospital stay developed UTIs, all of which were complicated types. SSI developed in 15%, where 2/3rd was superficial and 1/3rd was deep. Older age with a longer duration of catheterization and DJ stent was found to be associated with the occurrence of UTI, while older age and high BMI were related to the event of SSI. BSMMU J 2022; 15(2): 127-131

Hospital rating websites play a minor role for uro-oncologic patients when choosing a hospital for major surgery: results of the German multicenter NAVIGATOR-study

PurposeHospital rating websites (HRW) offer decision support in hospital choice for patients. To investigate the impact of HRWs of uro-oncological patients undergoing elective surgery in Germany.MethodsFrom 01/2020 to 04/2021, patients admitted for radical prostatectomy, radical cystectomy, or renal tumor surgery received a questionnaire on decision-making in hospital choice and the use of HRWs at 10 German urologic clinics.ResultsOur study includes n = 812 completed questionnaires (response rate 81.2%). The mean age was 65.2 ± 10.2 years; 16.5% were women. Patients were scheduled for prostatectomy in 49.1%, renal tumor surgery in 20.3%, and cystectomy in 13.5% (other 17.1%). Following sources of information influenced the decision process of hospital choice: urologists’ recommendation (52.6%), previous experience in the hospital (20.3%), recommendations from social environment (17.6%), the hospital's website (10.8%) and 8.2% used other sources. Only 4.3% (n = 35) used a HRW for decision making. However, 29% changed their hospital choice due to the information provided HRW. The most frequently used platforms were Weisse-Liste.de (32%), the AOK-Krankenhausnavigator (13%) and Qualitaetskliniken.de (8%). On average, patients rated positively concerning satisfaction with the respective HRW on the Acceptability E-Scale (mean values of the individual items: 1.8–2.1).ConclusionIn Germany, HRWs play a minor role for uro-oncologic patients undergoing elective surgery. Instead, personal consultation of the treating urologist seems to be far more important. Although patients predominantly rated the provided information of the HRW as positive, only a quarter of users changed the initial choice of hospital.

Robot-assisted sutureless partial nephrectomy for the treatment of fifteen bilateral renal masses in a patient with Von Hippel-Lindau syndrome: a case report from a high-volume robotic center.

Renal cell carcinoma is among major causes of death in patients with Von Hippel-Lindau (VHL) syndrome, and it usually presents with multiple and bilateral lesions that may require multiple renal surgeries. This, in turn, may compromise renal function, resulting in end-stage renal disease. To minimize renal function impairment in these patients, great importance is given to the preservation of functional parenchyma with the use of nephron-sparing techniques. Furthermore, new techniques such as off-clamp surgery, selective suturing or sutureless techniques may improve long-term functional outcomes. We described the case of a 27-year-old male patient with a family history of VHL disease affected by multiple, bilateral renal masses. He received bilateral, metachronous robot-assisted partial nephrectomies (RAPN) for a total of 15 renal lesions. No intra- or post-operative complications occurred, and the patient was discharged on the second postoperative day after both procedures. Serum creatinine after the second RAPN was 0.99mg/dl (baseline value was 1.11mg/dl). In patients with VHL syndrome and multiple renal lesions, robot-assisted partial nephrectomy, especially with the use of clampless and sutureless techniques, helps minimizing renal function impairment and should be performed when anatomically and technically feasible.

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.

Does temporary transfer to preoperative hemodialysis influence postoperative outcomes in patients on peritoneal dialysis? A retrospective cohort study.

The associations between preoperative transfer to hemodialysis (HD) and postoperative outcomes in patients on chronic peritoneal dialysis (PD) remain unknown. We conducted this retrospective cohort study to investigate whether preoperative HD could influence surgical outcomes in PD patients undergoing major surgeries. All chronic PD patients who underwent major surgeries from January 1, 2007, to December 31, 2020, at Peking University First Hospital were screened. Major surgery was defined as surgical procedures under general, lumbar or epidural anesthesia, with more than an overnight hospital stay. Patients under the age of 18, with a dialysis duration of less than 3 months, and those who underwent renal implantation surgeries and procedures exclusively aimed at placing or removing PD catheters were excluded. Patients involved were divided into either HD or PD group based on their preoperative dialysis status for further analysis. Of 105 PD patients enrolled, 65 continued PD, and 40 switched to HD preoperatively. Patients with preoperative HD were significantly more likely to develop postoperative hyperkalemia. The total complication rates were numerically higher in patients undergoing preoperative HD. After adjustment, the incidence of postoperative hyperkalemia or any other postoperative complication rates were similar between groups. There were no differences in long-term survival between the two groups. It does not seem indispensable for PD patients to switch to temporary HD before major surgeries.

Septic shock of abdominal urinary focus after renal surgery [Version 1; Peer Review - In process

Introduction: a 30 years and 12 days old female patient from the canton of La Troncal and mixed ethnicity on admission to the right lumbar fossa with the presence of a 5 cm orifice with a large amount of fetid purulent content that evolves to a diagnosis of septic shock of urinary vs. abdominal origin, acute perforated abdomen and retroperitoneal collection, for which on November 30, 2022 an exploratory laparotomy, ileostomy, right hemicolectomy, right nephrectomy, retroperitoneal collection drainage and drain placement were performed. Jackson Pratt's patient remains under sedoanalgesia with midazolam and fentanyl RASS -4. She is coupled to mechanical ventilation, afebrile with antibiotic therapy with meropenem and vancomycin, who presents elevated acute phase reactants with rising leukocytosis and neutrophilia. In addition, the culture revealed the presence of Gram-negative bacilli in the surgical wound. Case report: to present a complex clinical case where the post-surgical patient's condition was complicated, causing septic shock Conclusion: post-surgical complications are rare; however, they can be deadly and very complicated to treat, which urges health professionals to take the necessary measures to minimize this postoperative risk

Postoperatif Ağrı, İnsizyonel Herni ve Kozmetik Açıdan Modifiye Makuuchi İnsizyonunun Değerlendirilmesi: Gözlemsel Çalışma

Objective: The modified Makuuchi incision (MMI) consists of a midline incision from the xiphoid to just above the umbilicus, and a transverse incision to the 12th rib. It is J-shaped on the right and L-shaped on the left side. We aimed to evaluate the postoperative pain, incisional hernia, and cosmetic satisfaction of patients who underwent renal surgery with this technique. Material and Methods: Between January 1, 2015 and March 31, 2021, patients who performed simple, partial, and radical nephrectomy with MMI in our clinic were determined, and whose surgery was performed at least 3 months ago and had contact information in hospital records were called by phone. They were questioned in terms of incisional pain, incisional bulging or hernia, and cosmetic appearance. Results: A total of 152 patients with kidney surgery were identified. Ninety-seven were operated via MMI, and 57 of them were interviewed. Thirty-seven were male and 20 were female. The mean age was 55.3 years (21-86 years) and the mean postoperative follow-up period was 28 months (3-75 months). There was no patient with ongoing pain and was still in need of analgesics. Fortyfive patients (78.9%) stated that they were satisfied with the cosmetic appearance. One patient (1.7%) reported incisional bulging and 1 (1.7%) reported a hernia. Conclusion: In cases with large renal tumors or a history of previous abdominal surgery, MMI did not cause permanent and serious problems in terms of pain, cosmetic, and herniation. We think that it is useful to know this incision for urologists who are interted in complicated renal surgeries.

PS-B10-8: BLOCKADE OF AT1 RECEPTORS RESTORE P2/P1 WITHOUT CHANGING INTRACRANIAL PRESSURE IN RENOVASCULAR HYPERTENSIVE RATS WITH 0.3 M NACL AD LIBITUM

Objective: Renovascular hypertension is characterized by activation of the renin angiotensin aldosterone system, elevated sympathetic nerve activity and sodium appetite behavior. The association of increased sodium intake and hypertension can worsen the injury to end organs. We tested the effects of AT1 receptors blockade (losartan, 10 mg/kg iv) on mean arterial pressure (MAP), intracranial pressure (ICP) and P2/P1 ratio (index of brain compliance) in 2K1C rats with 0.3 M NaCl ad libitum. Design and Methods: Male Holtzman rats (150 tp 180 g) with water and food ad libitum received a silver clip around the left renal artery to induce 2K1C or no clip (SHAM surgery) resulting 3 groups: SHAM (n = 9), 2K1C (n = 9) and 2K1C/Na (n = 7), which had an additional bottle of 0.3 M NaCl ad libitum. Six weeks after the renal surgery, MAP and ICP were recorded under urethane anesthesia (1.2 g/kg iv) and the P2/P1 was calculated offline from the waveform. Saline (0.2 ml/rat) was used as control injection before losartan. Results: In SHAM rats, ICP and P2/P1 were not changed by losartan (7.8 ± 1.1 and 0.88 ± 0.02; vs. saline: 7.9 ± 1.1 and 0.83 ± 0.01 mmHg, respectively), while MAP was decreased (104 ± 5, vs. saline: 120 ± 3 mmHg, p < 0.05). In 2K1C, MAP, ICP and P2/P1 values were greater than SHAM (respectively, 196 ± 6, 14.7 ± 2.7 and 1.1 ± 0.03 mmHg, vs. SHAM; p < 0.05) and all of them were decreased by losartan pre-treatment (137 ± 6, 8.6 ± 1.3 and 0.87 ± 0.05 mmHg, vs. saline, respectively). In 2K1C-Na MAP and P2/P1 were greater than in SHAM (186 ± 7 and 1.15 ± 0.06 mmHg, vs sham p < 0.05) and were decreased by losartan (162 ± 8 and 0.87 ± 0.02 mmHg, vs. saline; p < 0.05), although the decrease in MAP after losartan was lesser than the observed in 2K1C rats (p < 0.05). In 2K1C-Na rats, ICP was not different from SHAM (10.8 ± 1.2, vs. SHAM: 7.8 ± 1.1 mmHg, p > 0.05) and losartan had no effect on ICP (10.3 ± 1.7, vs. saline: 10.8 ± 1.2 mmHg, p > 0.05). Conclusion: Even without a change in ICP, AT1 blockade in 2K1C-Na was effective in restoring P2/P1 ratio, suggesting a beneficial effect on brain compliance in this situation.

Human Kallikrein-2 and Free Prostate Specific Antigen as Biomarkers for Early Detection of Prostate Cancer, Sudan: A Case-Control Study

Background: Prostate cancer (PCa) is considered one of the major health threats facing males in Sudan. Prostate-specific antigen (PSA) test is the most important laboratory test used in the diagnosis of prostate cancer, the main disadvantage of PSA is its limited specificity, which triggered a lot of interest in development, more research on other markers such as serum human kallikrein-2 (KLK-2) and free prostate specific antigen (fPSA). Objectives: To evaluate the validity of serum kallikrein-2 (KLK-2) and free prostate specific antigen (fPSA) in the early detection of prostate cancer among Sudanese patients. Method: In this study seventy men were considered as a case subject, who were diagnosed as cancer prostate at Gezira Hospital for Renal Disease and Surgery (GHRDS), Sudan during the period February 2018 to July 2019. Randomly selected sixty patients of BPH patients and forty-five apparently healthy men as control subject. KLK-2, fPSA and PSA estimations were performed from serum samples using the principle of Enzyme Linked Immunosorbent Assay (ELISA). Results: The results revealed a highly significant difference between the serum levels individual biomarkers (KLK-2, fPSA, PSA) and multiple biomarkers (fPSA/PSA, KLK-2/fPSA, KLK-2/PSA) for patients with prostate cancer when compared with the control groups. Furthermore, the fPSA/PSA ratio was lower in the patients with prostate cancer (P value = 0.00) than in the control group, the fPSA/PSA ratio showed that best accuracy to differentiate prostate cancer from control group, fPSA cut-off value was found to be more than (18 ng/ml), with sensitivity (93%), specificity (80%), and odds ratio (55). Conclusions: The use of multiple biomarkers rather than individual biomarkers especially fPSA/PSA ratio improves the specificity as well as maintenance of higher sensitivity for early diagnosis of the prostate cancer.

Pre analysis of difficulty in renal tumor enucleation surgery based on deep learning and image automation evaluation

Pre analysis of difficulty in renal tumor enucleation surgery based on deep learning and image automation evaluation

Clinical Characteristics and Management of Renal Trauma: A Single-centre Observational Study

Introduction: The management of renal trauma includes operative and non operative approach based on clinical profile of patient. However, management of the high-grade renal trauma remains controversial. Aim: To evaluate mode of renal injury, staging and its management outcomes. Materials and Methods: This prospective, observational study included 49 patients (>15 years of age) who presented with abdominal trauma. Computed tomography was performed for grading of renal trauma. The patients were stratified based on whether they underwent open renal surgery or conservative management for their renal injury. Demographic characteristics and a detailed history of renal injuries were recorded. The patients were evaluated based on the rate of renal preservation and complications at 6-month follow-up. Results: The mean age was 32.10 years and majority of the patients were males (87.76%). Blunt trauma (95.92%) was most frequently reported. According to American Association for the Surgery of Trauma (AAST), 8 (16.33%) patients were categorized in grade I, 17 (34.69%) patients in grade II, 8 (16.33%) patients in grade III, 12 (24.49%) patients in grade IV, and 4 (8.16%) patients in grade V. Microscopic haematuria (42.86%) was the most common clinical presentation. The majority of the patients were managed conservatively (89.8%). Only two belonging to grade 4 and three from grade 5 were managed operatively due to haemodynamic instability. Rib fractures (n=10) were the most frequently associated injury, and Urinary Tract Infection (UTI) (n=8) was the most common complication, followed by persistent haematuria (n=3), and hypertension (n=3). All patients with grades I to III showed 100% renal preservation rate with conservative management. However, patients with grades IV and V showed renal preservation rate of 83.33% and 50%, respectively. Conclusion: Conservative treatment is a preferred choice of treatment in the most of the renal trauma. The present study reported high renal preservation rate in low-grade renal injuries, which were managed conservatively. However, there is still need of surgical treatment in high grade haemodynamically unstable patients.

ArtiSential<sup>TM</sup> Revolutionizes Traditional Laparoscopy in Urology by Introducing the Dexterity of a Robotic System to a Laparoscopic Instrument <br/>—First Experiences in Urology in Europe by the Ukrb in Neuruppin

We describe the first two conventional, laparoscopic renal operations with a new multi-degree of freedom articulated single-use laparoscopic instrument (ArtiSentialTM). The two patients underwent different laparoscopic interventions at Ukrb University (Neuruppin, Germany): nephrectomy and Anderson-Hynes-pyeloplasty. All procedures were completed, with no need for conversion or placement of additional ports. No intraoperative complications or technical failure of the instrument was recorded. The mean operative time was 180 min median length of stay was 11.5 d. The instrument could be opened out of the sterile packaging and used at once when it was needed, because it is a single-use instrument. There was real haptical feedback and the costs are minimal compared to robot surgery. The use was straightforward and rapid processes after an intensive training of 4 h in a dry lap. Awaiting future investigations in larger series, this study proves the safety and feasibility of renal surgery with ArtiSentialTM and provides relevant data that may help early adopters of this surgical instrument.

Perioperative Results of Open Renal Surgery in Patients with Dual Antiplatelet Therapy

Perioperative Results of Open Renal Surgery in Patients with Dual Antiplatelet Therapy

Analgesic effect of ultrasound-guided erector spinae plane block versus ultrasound-guided caudal block in pediatric open renal surgeries: A randomized comparative study

Analgesic effect of ultrasound-guided erector spinae plane block versus ultrasound-guided caudal block in pediatric open renal surgeries: A randomized comparative study

Evaluation of Clinical Implications of Renal Vessel Morphology during Renal Surgeries

Objective: Aim of this research to examine renal vessels and their morphologies as well as their clinical consequences during renal surgery. Study Design: Cross-sectional study Place and Duration: Anatomy department of Bacha Khan Medical Complex, Mardan and Multan Medical & Dental College Multan during the period from April 2022 to September 2022. Methods: There were 90 cases of both genders presented in this study. Included patients were aged between 20-80 years. With suspected abdominal diseases, patients were referred for abdominal CECT examinations. In contrast-enhanced MDCT images of the Abdomen, the renal arteries were examined for their normal structure and any abnormalities. SPSS 21.0 was used to analyze complete data. Results: Males were higher in numbers 61 (67.8%) than females. Mean age of the patients was 51.3±8.43 years and mean BMI 22.4±8.42 kg/m2. We found frequency of anatomical variations of the renal vessel in 62 (68.9%) cases. Frequency of variations of the renal artery was 47 (52.2%). Among 47 cases, supplementary renal artery was found in 41 (45.6%) cases. Early bifurcation of renal artery in 15 (16.7%). In 11 patients on the right side, 12 patients on the left side, and 3 individuals on both sides, an earlier branching of the renal artery was found. The right side was more often affected by renal vein variations, with 25 (278%) patients having late renal vein confluence and 6 (6.7%) patients having additional renal veins. Patients with late renal vein confluence (3.3%) and retroaortic vein (3.3%) were seen on the left side. Conclusion: Our findings in this research show renal artery alterations are common. Endovascular, laparoscopic, and urological procedures benefit from morphological examination of the renal vessels. Keywords: Abdominal disease, Renal Artery, Conventional Angiography, Anatomical Variations

Transversus abdominis plane block versus paravertebral block for post-operative pain following open renal surgeries: A randomized clinical trial

ABSTRACT Background : Open renal surgeries are usually associated with significant pain which may increase morbidity and mortality if left untreated. Several methods are used to control pain after these surgeries including opioids, non-steroidal anti-inflammatory drugs and regional anesthetic techniques. This study aimed at comparing the thoracic paravertebral block (PVB) versus transversus abdominis plane block (TAP) in patients undergoing open renal surgeries. Methods : Between November 2017 and November 2018 at Assiut University Hospital, urology department 60 patients undergone open renal surgeries had been randomly allocated into two groups; group (PVB) (n = 30) who received (PVB), and group (TAP) (n = 30) who received TAP block. The regional anesthetic technique was performed in each patient after induction of general anesthesia and before performing the surgery. The primary outcome was the total analgesic consumption in the first 24 h postoperatively. Secondary outcomes included the time to the first analgesic request and the Visual Analogue Scale score (VAS) during the first 24 h postoperatively. Results : Total analgesic consumption during the first 24 h postoperatively was significantly lower in PVB group compared to TAP group. The VAS scores were significantly lower in PVB group compared to TAP group during the first 12 h postoperatively. However, the time to first analgesic request was non-significant between both groups. Conclusions : The TAP block was effective, safe and comparable to PVB for pain control following open renal surgeries. However, the paravertebral block was more potent. Trial Registry : ClinicalTrials.gov: NCT04697420

Single Dose Diclofenac and Tamsulosin Effectiveness in Patients Undergoing Double J-Stent Removal Under Local Anaesthesia

Purpose The purpose of this study was to see effectiveness of diclofenac sodium and tamsulosin combination on patients’ pain perception after ureteral stent removal. Materials and Methods Study was carried out from October 2019 to March 2021. All patients with unilateral stent placement after renal or ureteric stone endoscopic surgery were randomized in 3 groups. Group-A include 20 patients who were given placebo drug 2-hours prior to double J (DJ) removal. Group-B included 20 patients who were given oral diclofenac 2-hours prior to DJ removal. Group-C included 20 patients who were given oral diclofenac and tamsulosin 2-hours prior to DJ removal. All patients received 10 cc 2% viscous lidocaine intraurethral before cystoscopy. No sedatives or analgesics were administered during the procedure. All patients provided consent before the procedure and they were asked to record their pain experience on a visual analog pain scale as soon as the procedure was finished. The pulse rate and systolic and diastolic blood pressure (BP) were also recorded 5-minutes before the procedure and during the procedure Results General characteristic of age, gender and indication for DJ-stenting were comparable in all groups. The mean pain score on the visual analogue scale (VAS) in Group-C was significantly lower than that in Group-A and B (p<0.001) A statistically significant difference was found between the two groups in terms of anxiety scores after cystoscopy, intraoperative systolic BP and pulse rate. Patients who were given oral diclofenac and tamsulosin two hours prior to DJ removal experienced less pain and anxiety. Conclusion Oral diclofenac plus tamsulosin combination prior to DJ removal improves patient’s comfort.

The State of Robotic Partial Nephrectomy: Operative, Functional, and Oncological Outcomes From A Robust Multi-Institution Collaborative

ObjectiveTo describe the most recent surgical, functional, and oncological outcomes of RPN utilizing one of the largest, prospectively maintained, multi-institution consortium of patients undergoing robotic renal surgery. Materials and MethodsData was obtained from a prospectively maintained multi-institutional database of patients who underwent RPN for clinically localized kidney cancer between 2018 and 2022 by 9 high-volume surgeons. Demographic and tumor characteristics as well as operative, functional, and oncological outcomes were queried. ResultsA total of 2836 patients underwent RPN. Intraoperative, postoperative, and 30-day major complication rates were 2.68%, 11.39%, and 3.24%, respectively. Median tumor size was 3.0 cm. Tumors with low complexity had a shorter median operative time, lower median EBL, shorter median ischemia time, lower postoperative complication rate, and lower decline in renal function There was no significant difference between tumor complexities with respect to the rate of conversion to radical nephrectomy, conversion to open, major complications, and positive margins. Lower BMI, smaller clinical tumor size, lower tumor complexity, and higher baseline eGFR were significantly associated with trifecta achievement. ConclusionPatient BMI, baseline eGFR, and tumor characteristics such as size and complexity are the most important predictors of trifecta achievement. Patients with complex tumors should be counseled that they are at increased risk of complications and worsening renal function after robotic partial nephrectomy.

Systematic Review of Comparative Studies of 3D Models for Preoperative Planning in Minimally Invasive Partial Nephrectomy

BACKGROUND: The employment of 3-dimensional (3D) virtual models of the organs and tumors, obtained from conventional 2-dimensional (2D) imaging (i.e. computed tomography scan and magnetic resonance imaging) have already demonstrated an outstanding potential in urology, especially in renal surgery. OBJECTIVES: The aim of this systematic review is to provide an updated focus on the results obtained from the preoperative employment of 3D virtual imaging reconstructions in nephron sparing oncological surgery. METHODS: A systematic literature search was conducted in April 2022 using Medline (via PubMed), Embase (via Ovid), Scopus, and Web of Science. The search strategy used PICO criteria and article selection was conducted in accordance with the PRISMA guidelines. The risk of bias and the quality of the articles included were assessed. A dedicated data extraction form was used to collect the data of interest. RESULTS: The initial electronic search identified 471 papers, of which 13 ultimately met the inclusion criteria and were included in the review. 11 studies reported outcomes of virtual models, 2 studies focused on printed 3D models. In these studies, the application of 3D models for preoperative planning has been reported to increase the selective clamping rate and reducing the opening of collecting system, blood loss and loss of renal function. CONCLUSIONS: 3D virtual models seem to provide some surgical benefits for preoperative planning especially for complex renal masses. In the future the continuous evolution of this technology may further increase its field of application and its potential clinical benefit.