SEARCH · Search PubMed
Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.
Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.
In the central regional hospital 50 nephrectomies were performed for traumas and different diseases of the kidney, 44 of them being fulfilled through a laparoscopic access. This access allowed the volume of operation to be expanded in 58% of the patients. In 8% of the patients massive hemorrhage took place. Four patients died. Nephrectomy following pretreatment of the renal vessels allows to reduce risk of the operation.
PURPOSE: To perform open donor nephrectomy with the least amount of body alteration and complication, a short extraperitoneal incision was developed that preserves the ipsilateral rectus abdominis muscle and abdominal branches of the intercostal nerves. MATERIALS AND METHODS: Donor nephrectomy using the new incision was performed in 11 consecutive patients. RESULTS: Morphine was required for pain relief for 1 to 3 days (mean 1.8), patients tolerated diet at 1 to 4 days (mean 2.2) and postoperative stay was 2 to 5 days (mean 3.5). Complications were minimal, consisting of postoperative fever 1 day in duration. A viable kidney was provided for transplantation in each case. CONCLUSIONS: The extraperitoneal, rectus abdominis muscle and nerve sparing incision resulted in a short course of pain medication, early diet toleration and a short hospital stay.
We describe a 12-year-old girl who died due to hypertensive encephalopathy and a 7-year-old boy with a favorable outcome after bilateral nephrectomy. Both had end-stage renal disease. Nephrectomy should be considered as a possible treatment of severe hypertension even without end-stage renal disease, if the patient has symptoms of hypertensive encephalopathy.
Since November 1994, when the first laparoscopic nephrectomy was made in Russia, 36 laparoscopic operations have been made on the kidney. 11 were nephrectomies, 21 were fenestrations of renal cysts, 4 transabdominal laparoscopies were unsuccessful.
PURPOSE: The 1997 TNM classification defines T1 tumors as those smaller than 7 cm. Recently, a cutoff point of 4 cm. has been proposed to create a subclass of T1 tumors. We evaluated the validity of this cutoff point by assessing the pathological findings and prognoses of patients with T1N0M0 renal cell carcinoma following radical nephrectomy. MATERIALS AND METHODS: We reviewed the hospital charts of 333 patients with T1N0M0 tumors, followed as long as 282 months (median 63) after radical nephrectomy. The validity of tumor size cutoff point for predicting survival outcome was tested in relation to other prognostic factors, including patient age, tumor position, nuclear grade, tumor histopathology and degree of microscopic venous invasion. RESULTS: During followup 32 patients (9.6%) had tumor recurrence and 21 (6.3%) died of renal cell carcinoma. A 5 cm. cutoff point maximized the differences in cancer specific survival rates and a 4 cm. cutoff point maximized the differences in disease-free survival rates. Tumor size was directly related to microscopic venous invasion and nuclear grade, which are significant prognostic factors, and a 4 cm. cutoff point enhanced these relationships. CONCLUSIONS: Tumor size is an important prognostic factor for patients with T1N0M0 renal cell carcinoma. A cutoff point of 4 cm. is practical for dividing the T1N0M0 classification into T1a and T1b subclasses.
From Sept. 1991 to Jan. 1999, we performed partial nephrectomy on 7 patients with renal cell carcinoma. The indication was imperative for 3 patients, and elective for 4 patients. The 3 imperative cases consisted of bilateral renal cell carcinomas, a polycystic kidney disease and a contralateral atrophic kidney. All 4 patients with elective indication revealed renal cell carcinoma with a normal functioning contralateral kidney. The tumor size ranged from 1.3 cm to 6.0 cm (2.7 cm on average). The mean clamping time of renal artery was 22 minutes and mean blood loss was 400 ml. The pathological stage was pT1a in 6 patients and pT1b in one patient. Postoperative follow-up ranged from 4 months to 92 months (mean: 43 months). One patient with bilateral renal cell carcinoma died of metastases to the lungs and brain at 25 months postoperatively. The remaining 6 patients are alive without recurrence and metastasis. We obtained a good postoperative course in our selected patients with low stage. Thus it was considered that partial nephrectomy is effective against small renal cell carcinoma.
The goals of conservative resection of renal cell carcinoma are complete local surgical removal of the malignancy and preservation of adequate renal function. This is a delicate balance, which makes renal preserving surgery at times both challenging and controversial. Surgical management of renal cell carcinoma remains the most effective curative management. The increased use of cross-sectional imaging has led to an increased detection of incidental renal cell carcinomas at an earlier stage. The indications of nephron-sparing surgery (NSS) have evolved in the past decade. Clinically, there are scenarios where nephron-sparing surgery is absolutely indicated. However, in the setting of a normal contralateral kidney, radical nephrectomy is still considered by many to be the treatment of choice for localized renal cell carcinoma. There is now growing evidence that in the correct patient, the use of NSS in the above-mentioned situation is justified. Very recent data indicate that NSS provides effective and equivalent oncologic treatment for most renal cell carcinomas especially those 4 cm or smaller. Refined surgical techniques and new studies regarding the earlier diagnosis and biology of renal cell carcinoma, true incidence of occult multifocality, and comparable morbidity with radical nephrectomy make NSS an attractive tool in the armamentarium of the urologic surgeon.
The role of laparoscopy in urologic surgery has greatly increased over the past decade as has the popularity of elective nephron-sparing surgery. The emergence of these trends in conjunction with improvements in equipment and expertise has led to the increasing application of laparoscopic partial nephrectomy. Initially, this modality was applied in patients with benign diseases, such as chronic pyelonephritis and calculus disease with associated atrophy. Concerns of tumor spillage and local-regional control precluded the application of the laparoscopic modality to small, indeterminate renal masses. However, increasing experience with the technique and advances in intraoperative imaging have prompted its use in removing small renal masses. Herein, we describe the indications for laparoscopic partial nephrectomy, the two approaches (transperitoneal and extraperitoneal) to gain access to the kidney, current options to assist in controlling intraoperative hemorrhage, a comprehensive assessment of the results for benign and malignant resections, and an examination of the similarities and contrasts between open and laparoscopic techniques.
Live donor renal transplantation provides significant advantages when compared with cadaveric renal transplantation. Unfortunately, there are disincentives associated with donation including prolonged hospitalization, significant postoperative pain, and prolonged convalescence. With the advent of laparoscopic donor nephrectomy, there has been an increase in live donation at centers performing the procedure secondary. Incentives provided by laparoscopic donation include a reduction in hospital stay, less postoperative analgesic requirements, and an earlier return to normal daily activities. Most importantly, graft function and survival are equivalent to open live donation. Laparoscopic donor nephrectomy is evolving to become the preferred method of procuring living donor kidneys.
PURPOSE: Ipsilateral adrenalectomy is usually performed during radical nephrectomy because of renal cell cancer. Because renal tumors are detected more often in the earlier stages due to widespread use of ultrasound and computerized tomography, we define a subset of patients who would be eligible for adrenal sparing surgery. In a retrospective analysis we evaluated whether parameters obtained preoperatively are able to predict adrenal metastasis. MATERIALS AND METHODS: A total of 866 consecutive patients who underwent nephrectomy and ipsilateral adrenalectomy from 1983 to 1999 were evaluated. Preoperative parameters, including tumor size, location, clinical stage, number of tumors, and patient age and sex, were retrospectively compared with the histological results. Univariate and multivariate analyses were performed. RESULTS: A total of 27 (3.1%) adrenal metastases were noted in the 866 patients, and 63% were on the left side and 37% on the right side. Mean tumor size was 10 cm. with versus 6 cm. without adrenal involvement. Of the 27 patients 21 had multiple metastases at diagnosis and only 6 (0.7% of all 866) presented with solitary ipsilateral adrenal metastasis. Univariate and multivariate analyses revealed tumor size and M stage as best preoperative predictors of adrenal involvement. CONCLUSIONS: Adrenal sparing surgery is possible, and we suggest a new algorithm. If maximum tumor size measured by computerized tomography is less than 8 cm. and staging examination does not show organ or lymph node metastases, adrenalectomy is not necessary because of oncological reasons. This algorithm has to be validated by a prospective analysis.
Renal grafts from living donors represent an important source of organs, particularly for young patients with chronic renal failure. Laparoscopic donor nephrectomy is a relatively new technique, which has the potential to increase the pool of available kidney grafts by removing some disincentives to live donation. The technique used for left kidney donation at our center, the first to introduce laparoscopic live donor nephrectomy in Italy, is described in this report. To further reduce warm ischemia time, the kidney is preloaded inside the extraction bag and 2 staplers are used to transect the renal artery and vein. The spread of the new technique in our country and in the rest of Europe is likely to raise the issue of training in laparoscopic surgery for transplant surgeons.
After some considerations on the problems of operation technique which are raised up by partial nephrectomy, the authors review its' indications. After presentation of the clinical experience based on ten cases of partial nephrectomy, carried out during the years 1972-1974, of which 7 were for lithiasis, 2 for renal tuberculosis and one for a solitary renal cyst, the authors advise primary ligature of the segmental vascular pedicle, whenever possible and use of the perinephretic fat to cover over the sectioned surface, as it has strong hemostatic action, good tolerance and that owing to this, nephropexy is carried out.
A 64-year-old woman, who had undergone right nephrectomy because of right incomplete double pyeloureter and dysplastic kidney with a ureteral stone at the age of 25, presented with a chief complaint of repeated urinary tract infection associated with right lower abdominal pain. A diagnosis of empyema of the ureteral stump with multiple stones was made based on X-ray findings and cystoscopy. In December 1999, the right residual ureter and ureteral stones were removed. Histopathologically, non-specific inflammatory change and fibrosis of the wall were observed. The ureter including the stones should have been resected at the previous nephrectomy.
Right nephrectomy and ligation of the left renal vein often lead to acute renal failure, but not obligatorily to renal infarction and chronic uremia, thanks to the peculiar venous supply of the left kidney. A man underwent right nephrectomy, inferior cavectomy and ligation of the left renal vein and became anuric. Hemodialysis was necessary for some days, but he partially recovered his renal function. Proteinuria occurred a few days after the operation and decreased but had not disappeared after ten months. Eventually the patient died of brain metastases. There are a few reports of similar operations, some successful, others not, but very few papers report an adequate follow-up of subsequent changes in renal function. Nephrologists could be involved in the postoperative care of these cases. They should be aware of the possible recovery of renal function and should try all possible strategies to help the left kidney recover its function.
Unilateral single vaginal ectopic ureteral opening with ipsilateral hypoplastic kidney is a rare disease. It is classically presented with continuous urinary incontinence, but a normal voiding pattern after successful toilet training. The kidneys associated with this condition are usually nonfunctional and nephrectomy is the treatment of choice to cure the incontinence. We present a 7-year old girl with such a problem successfully treated by retroperitoneal laparoscopy. The patient resumed her normal unrestricted activity level on postoperative day 3. She was free of symptoms related to the operation during a 6-year follow-up period. It is suggested from this case that despite the reduced working space in children, retroperitoneal laparoscopic nephrectomy in the treatment of small kidney with complications is a feasible procedure.
The study included 26 patients with renal carcinoma (RC) stage T1 which have undergone elective conservative surgery and 33 patients with the same disease after radical nephrectomy. To compare their postoperative quality of life, the patients filled in questionnaire EORTC QLQ-C30 (version 3) for cancer patients. The results of the questionnaire survey show a higher quality of life in RC patients after organ-saving operations, i.e. their physical condition is better, social adaptation faster. High quality of life and good 5-year survival suggest that conservative elective surgery in renal carcinoma stage T1 is an alternative to radical nephrectomy.
Laparoscopy has greatly evolved over the years. More recently, retroperitoneoscopy has gained wide acceptance as the preferred approach for simple and complicated nephrectomies. We report on a 12 year-old girl who underwent a left nephrectomy on a horseshoe kidney through a retroperitoneoscopic approach using the harmonic scalpel for dissection and isthmus division. The operation was successful, recovery uneventful, and the patient was discharged 24 hrs post operatively, with excellent cosmesis. Retroperitoneoscopy can be considered if ablative surgery is contemplated in a horseshoe kidney, with adequate preoperative evaluation and solid retroperitoneoscopic surgical experience. The use the harmonic scalpel was greatly beneficial for the overall success of this complicated intervention.
Laparoscopic management of kidney cancer is becoming accepted as an alternative to open radical nephrectomy. Technical considerations have limited the application of laparoscopic radical nephrectomy to relatively small, clinically localized tumors. At the National Cancer Institute, we have broadened the indications to include bulky tumors. Herein, we describe the operation with attention to the technical caveats that have been gained with experience.