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Gieraerts C, Vanhoutte E, Laenen A, Bonne L, De Wever L, Joniau S, Oyen R, Maleux G. Safety and efficacy of embolotherapy for severe hemorrhage after partial nephrectomy. Acta Radiol 2020; 61:1701-1707. [PMID: 32102548 DOI: 10.1177/0284185120907253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Partial nephrectomy may be complicated by postoperative hemorrhage, which may be treated by transcatheter embolization. PURPOSE To assess the safety and efficacy of embolotherapy for hemorrhagic complications of partial nephrectomy and to analyze the potential correlation between multiple bleeding sites on angiography and surgical complexity. MATERIAL AND METHODS A cohort of 25 patients presenting with severe, postoperative bleeding after partial nephrectomy and treated with catheter-directed superselective embolization was included. Patients' demographics, radiological investigations before the embolization, and clinical outcome after embolization were analyzed. Mann-Whitney U test was used to analyze the potential difference in the RENAL score between patients with one or more bleeding sites in the resection area. RESULTS Selective renal angiography revealed multiple bleeding sites at the resection bed in 8 (32%) patients with amorphous contrast extravasation in 10 (40%) patients. Embolization with use of a microcatheter and microcoils was effective to stop the bleeding in all but one patient, the latter requiring a second embolization two days later. Transient decrease in renal function was noted in 3/25 (12%) patients with full recovery in two of the three. Patients with multiple bleeding sites did not show significantly different RENAL scores compared to patients with a single bleeding site (P = 0.148). CONCLUSION Embolotherapy for postoperative partial nephrectomy-related bleeding is safe and effective with a low rate of recurrent bleeding. The number of bleeding sites at the resection area did not correlate to the RENAL score.
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Affiliation(s)
| | - Els Vanhoutte
- Department of Radiology, University Hospitals Leuven, Leuven, Belgium
| | - Annouschka Laenen
- Department of Biostatistics and Statistical Bioinformatics, KU Leuven Universiteit Hasselt, Leuven, Belgium
| | - Lawrence Bonne
- Department of Radiology, University Hospitals Leuven, Leuven, Belgium
| | - Liesbeth De Wever
- Department of Radiology, University Hospitals Leuven, Leuven, Belgium
| | - Steven Joniau
- Department of Urology, University Hospitals Leuven, Leuven, Belgium
| | - Raymond Oyen
- Department of Radiology, University Hospitals Leuven, Leuven, Belgium
| | - Geert Maleux
- Department of Radiology, University Hospitals Leuven, Leuven, Belgium
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Kisa E, Koc G, Yucel C, Keskin MZ, Capar AE, Kozacioglu Z. Renal artery pseudoaneurysm after open partial nephrectomy for renal cell carcinoma. Urologia 2019; 87:11-14. [PMID: 31280692 DOI: 10.1177/0391560319862250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Renal artery pseudoaneurysm is a well-described complication of open and laparoscopic partial nephrectomy. Delayed bleeding from a renal artery pseudoaneurysm is rare after open partial nephrectomy. CASE DESCRIPTION Here, we present a 75-year-old man who, 14 days after undergoing an open right partial nephrectomy for an endophytic 4.5 cm tumor, developed painless macroscopic hematuria. Prompt computer tomography angiography imaging, followed by therapeutic angio-embolization of segmental renal artery with coils, treated the pseudoaneurysm successfully. CONCLUSION Renal artery pseudoaneurysm can be treated rapidly, effectively, and with minimal patient morbidity via percutaneous renal artery embolization.
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Affiliation(s)
- Erdem Kisa
- Tepecik Training and Research Hospital, İzmir, Turkey
| | - Gokhan Koc
- Tepecik Training and Research Hospital, İzmir, Turkey
| | - Cem Yucel
- Tepecik Training and Research Hospital, İzmir, Turkey
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Kisa E, Sahin H, Cakmak O, Yucel C, Koc G, Kozacioglu Z, Ilbey YO. Magnetic resonance imaging characteristics and changes in hemostatic agents after partial nephrectomy. Int Urol Nephrol 2019; 51:917-925. [PMID: 30955139 DOI: 10.1007/s11255-019-02141-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Accepted: 04/02/2019] [Indexed: 12/24/2022]
Abstract
PURPOSE To evaluate the characteristics of images generated by magnetic resonance imaging (MRI) and changes in the mass-like lesion (MLL) during the follow-up of patients who underwent partial nephrectomy (PN) with the intra-operative use of hemostatic agents (HAs). METHODS The records of patients who had undergone PN in our clinic due to renal mass between January 2013 and August 2018 were retrospectively reviewed. Our study included 47 patients who were administered one or more HAs during the PN and who received diffusion and dynamic MRI at the post-operative 2nd/4th Queryand 12th month. RESULTS MLL is defined as T2 heterogeneous, intermediate-signal intensity bolster-related mass with a pseudocapsule in the renal parenchymal defect. When we looked at the morphological changes of MLL, the mean largest axial dimensions of masses were 27.3 (range 12.2-44.7) mm in the first follow-up period (2nd/4th months) and 21.2 (range 11-44.7) mm in the 12th month follow-up period. The average change in size of MLL was - 0.66 mm/month. We did not see any significant relationship between observation of MLL in the post-operative follow-up MRI images and the use of HAs such as Surgicel®, Spongostan®, and autologous fatty tissue as well as the amount of the agents used in PN operations (p = 0.405, p = 0.159, respectively). CONCLUSIONS The distinction of MLL causing bolster-related mass and granulomatosis tissue from relapse/recurrence can be made based on the change in mass size observed in the MR images and image characteristics.
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Affiliation(s)
- Erdem Kisa
- Department of Urology, Tepecik Training and Research Hospital, Güney Mahallesi, 1140/1. Sk. No:1, Yenişehir, Konak, 35180, Izmir, Turkey.
| | - Hilal Sahin
- Department of Radiology, Tepecik Training and Research Hospital, Güney Mahallesi, 1140/1. Sk. No:1, Yenişehir, Konak, 35180, Izmir, Turkey
| | - Ozgür Cakmak
- Department of Urology, Tepecik Training and Research Hospital, Güney Mahallesi, 1140/1. Sk. No:1, Yenişehir, Konak, 35180, Izmir, Turkey
| | - Cem Yucel
- Department of Urology, Tepecik Training and Research Hospital, Güney Mahallesi, 1140/1. Sk. No:1, Yenişehir, Konak, 35180, Izmir, Turkey
| | - Gokhan Koc
- Department of Urology, Tepecik Training and Research Hospital, Güney Mahallesi, 1140/1. Sk. No:1, Yenişehir, Konak, 35180, Izmir, Turkey
| | - Zafer Kozacioglu
- Department of Urology, Tepecik Training and Research Hospital, Güney Mahallesi, 1140/1. Sk. No:1, Yenişehir, Konak, 35180, Izmir, Turkey
| | - Yusuf Ozlem Ilbey
- Department of Urology, Tepecik Training and Research Hospital, Güney Mahallesi, 1140/1. Sk. No:1, Yenişehir, Konak, 35180, Izmir, Turkey
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Zapala P, Dybowski B, Miazek N, Radziszewski P. Open partial nephrectomy for entirely intraparenchymal tumors: a matched case-control study of oncologic outcome and complication rate. Int Braz J Urol 2017; 43:209-215. [PMID: 28128905 PMCID: PMC5433358 DOI: 10.1590/s1677-5538.ibju.2016.0040] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Accepted: 11/05/2017] [Indexed: 05/29/2023] Open
Abstract
Purpose To compare the oncologic and clinical outcomes for open partial nephrectomy (OPN) performed in patients with entirely intraparenchymal tumors versus case-matched controls, with exophytic lesions. Material and methods Patients having undergone OPN between 2007 and 2012 were investigated. Exclusion criteria included patients with a benign tumor, advanced malignancy, malignancies other than renal cell carcinoma, end-stage renal failure, or 3 or more co-existing chronic diseases. Individuals with tumors that were invisible at the renal surface were identified, and then matched with 2 controls chosen for tumor size, pathology, age, follow-up period, and presence of a solitary kidney. Oncological status, perioperative, and postoperative data were collected and compared between groups. Results 17 individuals with entirely endophytic RCC tumors and available oncologic status were identified. For five patients, only one suitable control could be identified, bringing the control group number to 29. All tumors were clear cell carcinomas staged at pT1a. Median tumor size was 25mm for endophytic lesions, and 27mm for exophytic masses (P=0.32). The operative period was extended by 20 minutes for intrarenal tumors (P=0.03), with one case of a positive surgical margin in each group (P=0.7). There were no significant differences in perioperative or postoperative complications. Median follow-up was 47 and 43 months for patients with endophytic and exophytic tumors respectively. Disease recurrence was recorded in one patient after endophytic tumor resection, and in four controls (P=0.4). Conclusions OPN shows equivalent safety and efficacy for both intrarenal RCC tumors and exophytic tumors of the same size and type.
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Affiliation(s)
- Piotr Zapala
- Department of Urology, Medical University of Warsaw, Poland
| | | | - Nina Miazek
- Department of Urology, Medical University of Warsaw, Poland
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Renal Autotransplantation and Extracorporeal Nephron-Sparing Surgery for De Novo Renal Cell Carcinoma in a Kidney Allograft. Transplant Direct 2017; 3:e122. [PMID: 28795136 PMCID: PMC5540622 DOI: 10.1097/txd.0000000000000714] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Accepted: 06/01/2017] [Indexed: 01/20/2023] Open
Abstract
De novo renal cell carcinoma (RCC) rarely occurs in kidney allografts; however, the risk of RCC in these patients is 100-fold that of the general healthy population. Although total nephrectomy has been the standard treatment for kidney allograft RCC, several authors have reported that early-stage RCC in kidney allografts was successfully treated with nephron-sparing surgery. We herein describe a new procedure involving renal autotransplantation and extracorporeal nephron-sparing surgery, which was performed to treat de novo RCC near the hilum of a transplanted kidney. In the 22 months since transplantation, the patient's renal function has been favorable, and no recurrence has been observed. In conclusion, renal autotransplantation is a feasible technique for the treatment of RCC in kidney allografts, especially RCC located near the hilum.
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Abstract
Laparoscopic radical nephrectomy has become a well-standardized and reproducible, but technically demanding procedure. It is rapidly replacing the traditional open technique in radical nephrectomy with T1-2 tumours. Open operation will mainly be reserved for T3 tumours. Nephron-sparing surgery will play a major role in small (<4 cm) peripheral tumours. Open technique is still the standard for NSS, but with the refined techniques, laparoscopy may be soon coming.
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Affiliation(s)
- K Taari
- Department of Urology, Helsinki University Hospital, Helsinki, Finland.
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Mearini L, Nunzi E, Vianello A, Di Biase M, Porena M. Margin and complication rates in clampless partial nephrectomy: a comparison of open, laparoscopic and robotic surgeries. J Robot Surg 2016; 10:135-44. [DOI: 10.1007/s11701-016-0584-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2015] [Accepted: 03/28/2016] [Indexed: 10/21/2022]
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Fu D, Li P, Xu F, Tian F, Xu XF, Wei ZF, Zhang ZY, Ge JP, Cheng W. Ultrasound-guided open nephron sparing surgery without renal artery occlusion for central renal tumors. ACTA ACUST UNITED AC 2016; 36:118-120. [PMID: 26838751 DOI: 10.1007/s11596-016-1552-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2015] [Revised: 12/03/2015] [Indexed: 11/26/2022]
Abstract
From January 2008 to January 2013, 11 patients with central renal tumors underwent ultrasound-guided open nephron sparing surgery (ONSS) without renal artery occlusion. We removed the lesions, and the cut edges of the tumors were negative. Thus, we deduced that ultrasound-guided ONSS is suitable for the cases with obscure tumor boundary or multiple lesions. It could achieve the purpose of thoroughly removing lesions, as well as to expand the application range of nephron sparing surgery.
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Affiliation(s)
- Dian Fu
- Department of Urology, Nanjing Jinling Hospital, Nanjing University School of Medicine, Nanjing, 210002, China
| | - Ping Li
- Department of Urology, Nanjing Jinling Hospital, Nanjing University School of Medicine, Nanjing, 210002, China
| | - Feng Xu
- Department of Urology, Nanjing Jinling Hospital, Nanjing University School of Medicine, Nanjing, 210002, China
| | - Feng Tian
- Department of Urology, Nanjing Jinling Hospital, Nanjing University School of Medicine, Nanjing, 210002, China
| | - Xiao-Feng Xu
- Department of Urology, Nanjing Jinling Hospital, Nanjing University School of Medicine, Nanjing, 210002, China
| | - Zhi-Feng Wei
- Department of Urology, Nanjing Jinling Hospital, Nanjing University School of Medicine, Nanjing, 210002, China
| | - Zheng-Yu Zhang
- Department of Urology, Nanjing Jinling Hospital, Nanjing University School of Medicine, Nanjing, 210002, China
| | - Jing-Ping Ge
- Department of Urology, Nanjing Jinling Hospital, Nanjing University School of Medicine, Nanjing, 210002, China
| | - Wen Cheng
- Department of Urology, Nanjing Jinling Hospital, Nanjing University School of Medicine, Nanjing, 210002, China.
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Güneyli S, Gök M, Bozkaya H, Çınar C, Tizro A, Korkmaz M, Akın Y, Parıldar M, Oran İ. Endovascular management of iatrogenic renal arterial lesions and clinical outcomes. Diagn Interv Radiol 2016; 21:229-34. [PMID: 25835080 DOI: 10.5152/dir.2014.14286] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
PURPOSE We aimed to evaluate iatrogenic renal arterial lesions, including pseudoaneurysm, arteriovenous fistula, and arteriocaliceal fistula, their management by endovascular embolization, and the clinical results. METHODS Fifty-five patients (forty males, fifteen females) with a median age of 40 years (range, 8-85 years), who underwent endovascular embolization of iatrogenic renal arterial lesions between March 2003 and December 2013 were included in this retrospective study. Types of iatrogenic lesions and details of embolization procedures were reported. Estimated glomerular filtration rate (eGFR), renal function tests, hemoglobin, and hematocrit levels before and after embolization were recorded and compared. RESULTS Median follow-up was 24 months. We identified 53 pseudoaneurysms, 30 arteriovenous fistulas, and 11 arteriocaliceal fistulas in 55 patients, after percutaneous nephrolithotomy (n=26), renal biopsy (n=21), nephrostomy (n=3), renal surgery (n=3), and extracorporeal shock wave lithotripsy (n=2). Median number of pseudoaneurysms was 1 (range, 1-4) with a median size of 7 mm (range, 1.5-35 mm). Fifty-one patients underwent coil embolization. Median number of coils was 5 (range, 2-21) and median renal parenchymal loss was 5% (range, 1%-50%). There were no significant differences between pre- and postoperative eGFR and serum parameters. CONCLUSION Iatrogenic renal arterial lesion can be a life threatening condition. Superselective coil embolization is a safe, minimally invasive treatment option with minimal renal parenchymal loss and without significant change in renal function.
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Affiliation(s)
- Serkan Güneyli
- Department of Radiology, Bülent Ecevit University School of Medicine, Zonguldak, Turkey.
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Jang HA, Kim JW, Byun SS, Hong SH, Kim YJ, Park YH, Yang KS, Cho S, Cheon J, Kang SH. Oncologic and Functional Outcomes after Partial Nephrectomy Versus Radical Nephrectomy in T1b Renal Cell Carcinoma: A Multicenter, Matched Case-Control Study in Korean Patients. Cancer Res Treat 2015; 48:612-20. [PMID: 26044158 PMCID: PMC4843725 DOI: 10.4143/crt.2014.122] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2014] [Accepted: 04/16/2015] [Indexed: 02/08/2023] Open
Abstract
Purpose The study was to compare the oncologic and functional outcomes of partial nephrectomy (PN) and radical nephrectomy (RN) for pathologically proven T1b renal cell carcinoma using pair-matched groups. Materials and Methods We reviewed our prospectively maintained database for RN and PN in T1b renal tumors surgically treated between 1999 and 2011 at five institutions in Korea. Of 611 patients treated with PN or RN for a solitary and NX/N0 M0 renal mass (4-7 cm), 577 (PN, 100; RN, 477) patients with pathologically confirmed pT1b remained for analysis. Study subjects were grouped by PN or RN, then matched by age, sex, comorbidities, body mass index, tumor size and depth, histologic type, and preoperative estimated glomerular filtration rate (eGFR) using propensities score. To evaluate oncologic outcomes, overall survival (OS), cancer-specific survival (CSS), and progression-free survival (PFS) rates were analyzed. The functional outcomes were evaluated by postoperative eGFR. Results The median follow-up in the RN group was 48.1 and 42.6 months in the PN group. The estimated 10-year CSS rate (PN 85.7% vs. RN 84.4%, p=0.52) and 5- and estimated 10-year PFS rates (PN: 86.4% and 79.2% vs. RN: 86.0% and 66.1%, p=0.66) did not differ significantly between groups. The estimated 10-year OS rate was significantly higher in the PN group (85.7%) compared to the RN group (73.3%) (p=0.003). PN was less likely to induce new-onset chronic kidney disease (CKD) and end-stage CKD compared with RN. Conclusion Our study suggests that patients treated with PN demonstrate a superior OS rate and postoperative renal function with analogous CSS and PFS rates compared with pair-matched patients treated with RN.
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Affiliation(s)
- Hoon Ah Jang
- Department of Urology, Korea University College of Medicine, Seoul, Korea
| | - Jin Wook Kim
- Department of Urology, Chung-Ang University College of Medicine, Seoul, Korea
| | - Seok Soo Byun
- Department of Urology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Sung Hoo Hong
- Department of Urology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Young Jun Kim
- Department of Urology, College of Medicine, Chungbuk Nation al University, Cheongju, Korea
| | - Young Hyun Park
- Department of Urology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Kyung Suk Yang
- Department of Biostatistics, Korea University College of Medicine, Seoul, Korea
| | - Seok Cho
- Department of Urology, Korea University College of Medicine, Seoul, Korea
| | - Jun Cheon
- Department of Urology, Korea University College of Medicine, Seoul, Korea
| | - Seok Ho Kang
- Department of Urology, Korea University College of Medicine, Seoul, Korea
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Abstract
INTRODUCTION Laparoscopic partial nephrectomy is still one of the more challenging procedures in urology. Minimizing warm ischemia time (WIT) and bleeding requires efficient intracorporeal suturing. In addition, achieving negative surgical margins requires complete excision of the tumor. Robotic-assisted partial nephrectomy (RALPN) adds the advantages offered by the "Da Vinci system" to laparoscopy, such as the 3-D vision, and the better degree of freedom of surgical instruments. OBJECTIVE The objective of this study is to report our experience with RALPN. METHODS From August 2009 to October 2012, 60 patients underwent RALPN for kidney cancer. The average age of the patients (35 female, 25 male) was 63 (range 48-80) years. Average BMI was 25 (range 21.8-29.7) kg/m2. Average tumor size was 3.2 cm (range 2-6.7 cm). All the procedures were performed by a transperitoneal approach. Ilar clamping was used in all cases: in 47 patients by one intracorporeal tourniquet for the artery and one for the vein; in three cases, ilar clamping was "en block" by Satinsky. RESULTS Mean operative time was 167.2 min (140-250) with a WIT of 23.8 min (15-28). The mean estimated blood loss was 260 mL (50-300). In one case, nephrectomy was necessary because the tumor involved the renal pedicle. One patient had pulmonary embolism and one urinary leakage conservatively managed.Pathologic examination revealed clear cell renal cell carcinoma in 58 patients, oncocytoma in one patient, and angiomyolipoma in one patient. All resection margins were free from tumor. CONCLUSIONS Partial nephrectomy, facilitated by robotic technology, is more and more frequently performed as a safe and effective minimally invasive procedure.
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[Combined approach of laparoscopic and open surgery for complex renal lesions]. Actas Urol Esp 2013; 37:120-6. [PMID: 22981794 DOI: 10.1016/j.acuro.2012.06.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2012] [Accepted: 06/30/2012] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To develop a combined surgical approach (laparoscopic and open) that allows an increased vascular control and decreased ischemia time, maintaining the advantages of pure laparoscopic partial nephrectomy (LPN). MATERIAL AND METHODS During the laparoscopic phase, dissection of the kidney and its pedicle is achieved. Then, an open approach is initiated through a mini-laparotomy, with the kidney being brought to the incision, improving the identification and exposition of the tumors. Following tumor identification by ultrasound, exeresis of the lesion is performed with or without vascular clamping. RESULTS Through this approach we performed the excision of complex lesions in 6 patients. Mean surgical time was 192 minutes (range 180-210) and mean warm ischemia time was 13 minutes (0-22), with a mean blood loss of 267 mL (100-500). Average pre and postoperative glomerular filtration rate was 51.5 (28-90) and 48.8 mL/min/1.73 m(2) (19-90), respectively. In one patient, suture repair of the pelvicaliceal system was needed, with no other perioperative morbidities being reported. CONCLUSIONS This combined approach is a minimally invasive surgical alternative, reproducible and safe which preserves the virtues of pure LPN. It allows a better control of the vascular pedicle, reducing the risk of hemorrhage and the warm ischemia time. This technique may be either considered in the treatment of renal masses with indication for partial nephrectomy but of complex laparoscopic approach or as a surgical approach in the early learning curve of the LPN.
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Gallego Vilar D, José Povo Martin I, Miralles Aguado J, Garau Perelló C, Bosquet Sanz M, Gimeno Argente V, Cifrián M, García Vila J, Gallego Gómez J. Ablación con radiofrecuencia como alternativa de tratamiento para el tumor renal localizado. Actas Urol Esp 2010. [DOI: 10.1016/j.acuro.2010.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Povo-Martín I, Gallego-Vilar D, Rodrigo-Aliaga M, García-Vila J. Pseudoaneurisma de arteria renal tras nefrectomía parcial laparoscópica. Diagnóstico, tratamiento y revisión bibliográfica. Actas Urol Esp 2010. [DOI: 10.1016/j.acuro.2009.12.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Salagierski M, Salagierski MS, Salagierska-Barwińska A. Radiofrequency ablation in kidney tumour management: A method of real-time monitoring. ACTA ACUST UNITED AC 2010; 44:84-90. [DOI: 10.3109/00365590903555385] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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Bird VG, Carey RI, Ayyathurai R, Bird VY. Management of renal masses with laparoscopic-guided radiofrequency ablation versus laparoscopic partial nephrectomy. J Endourol 2009; 23:81-8. [PMID: 19118475 DOI: 10.1089/end.2008.0087] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND AND PURPOSE Laparoscopic-guided radiofrequency ablation (LRFA) has been introduced as a minimally invasive nephron-sparing management option for renal tumors. Many patients who desire treatment present with multiple comorbidities, which poses a therapeutic challenge. Our purpose is to determine if multipass LRFA is comparable, in terms of surgical risk and immediate postoperative outcomes, to laparoscopic partial nephrectomy (LPN). PATIENTS AND METHODS A retrospective study identified 36 and 33 patients who underwent LRFA and LPN, respectively. Perioperative demographic data, tumor characteristics, and follow-up data were evaluated. Statistical analysis was performed using the Student t test and chi-square analysis. RESULTS Age, American Society of Anesthesiology score, and Charlson Comorbidity Index were significantly higher in the LRFA group than the LPN group (P < 0.001). Average tumor size was 2.8 cm and 3.1 cm for the LRFA and LPN groups, respectively. There were no significant differences in change between the preoperative and postoperative creatinine/glomerular filtration rate values or perioperative complication rates for the groups. Estimated blood loss and length of stay were significantly lower for the LRFA group than the LPN group (P < 0.05). Follow-up ranged 6 to 23 months and 6 to 58 months for the LRFA and the LPN groups, respectively. There has been no evidence of tumor recurrence in the follow-up period. CONCLUSIONS We present our initial report comparing patients undergoing LRFA v LPN for the management of renal tumors. Our preliminary results with our experience with multipass laparoscopic-guided RFA demonstrate that this technique can be safely used in an elderly, higher risk population. Long-term follow-up is needed to determine oncologic efficacy.
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Affiliation(s)
- Vincent G Bird
- Department of Urology, University of Miami, Miller School of Medicine, Miami, Florida 33136, USA
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Joniau S, Eeckt KV, Srirangam SJ, Van Poppel H. Outcome of nephron-sparing surgery for T1b renal cell carcinoma. BJU Int 2009; 103:1344-8. [DOI: 10.1111/j.1464-410x.2008.08230.x] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Nadu A, Kleinmann N, Laufer M, Dotan Z, Winkler H, Ramon J. Laparoscopic Partial Nephrectomy for Central Tumors: Analysis of Perioperative Outcomes and Complications. J Urol 2009; 181:42-7; discussion 47. [DOI: 10.1016/j.juro.2008.09.014] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2008] [Indexed: 11/25/2022]
Affiliation(s)
- Andrei Nadu
- Department of Urology, Sheba Medical Center, Tel Hashomer, Israel
| | - Nir Kleinmann
- Department of Urology, Sheba Medical Center, Tel Hashomer, Israel
| | - Menachem Laufer
- Department of Urology, Sheba Medical Center, Tel Hashomer, Israel
| | - Zohar Dotan
- Department of Urology, Sheba Medical Center, Tel Hashomer, Israel
| | - Harry Winkler
- Department of Urology, Sheba Medical Center, Tel Hashomer, Israel
| | - Jacob Ramon
- Department of Urology, Sheba Medical Center, Tel Hashomer, Israel
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Radiologic evaluation of small renal masses (II): posttreatment management. Adv Urol 2008:918050. [PMID: 18825274 PMCID: PMC2553898 DOI: 10.1155/2008/918050] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2008] [Accepted: 08/05/2008] [Indexed: 11/24/2022] Open
Abstract
The increase in the detection of small renal masses (SRMs) and their best knowledge leads to a change in the therapeutic management of these lesions. The use of a less aggressive surgical technique or even an expectant attitude is the current tendency, in order to preserve as much renal function as possible. Imaging techniques are essential in the followup of these lesions. It allows us to know the postsurgical changes and possible complications due to treatment and the presence of local recurrence and metastases. Furthermore, a close radiological followup of SRM related to ablative treatments is mandatory. The purpose of this article is to reveal the imaging features of complications due to surgical or ablative treatments, local recurrence and metastasis, as well as their followup.
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Abstract
Advances in imaging techniques (CT and MRI) and widespread use of imaging especially ultrasound scanning have resulted in a dramatic increase in the detection of small renal masses. While open partial nephrectomy is still the reference standard for the management of these small renal masses, its associated morbidity has encouraged clinicians to exploit the advancements in minimally invasive ablative techniques. The last decade has seen the rapid development of laparoscopic partial nephrectomy and novel ablative techniques such as, radiofrequency ablation (RFA), high-intensity focused ultrasound (HIFU), and cryoablation (CA). In particular, CA for small renal masses has gained popularity as it combines nephron-sparing surgery with a minimally invasive approach. Studies with up to 5-year followup have shown an overall and cancer-specific 5-year survival of 82% and 100%, respectively. This manuscript will focus on the principles and clinical applications of cryoablation of small renal masses, with detailed review of relevant literature.
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Cimsit NC, Baltacioglu F, Cengic I, Akpinar IN, Ilker Y, Turkeri L. Transarterial glue embolization in iatrogenic renovascular injuries. Int Urol Nephrol 2008; 40:875-9. [PMID: 18437524 DOI: 10.1007/s11255-008-9380-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2007] [Accepted: 03/25/2008] [Indexed: 11/30/2022]
Abstract
Iatrogenic injuries of the intrarenal arterial system include pseudoaneurysms and fistulas. They can cause hematuria and life-threatening hemodynamic instability, and therefore should be treated promptly. Endovascular treatment is recommended for these cases due to its effectiveness. Among the different agents used for embolization, n-butyl-2-cyanoacrylate (glue) has rarely been used. We present 15 patients with pseudoaneurysms and/or arteriovenous or caliceal fistulas who were treated by glue embolization. In our patient group, five had a history of percutaneous nephrolithotomy, six had renal biopsies, three had nephron-sparing surgery, and one had percutaneous nephrostomy. Glue embolizations were performed with the microcatheter technique. All patients were successfully treated, and all but one had excellent follow-ups. One patient suffered from disseminated intravascular coagulation secondary to transfusion and died after the procedure. We think glue embolization is a safe and effective treatment for this group of patients and present our experience along with the technical approach.
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Affiliation(s)
- Nuri Cagatay Cimsit
- Faculty of Medicine, Department of Radiology, Marmara University, Istanbul, Turkey.
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Meyer M, Velte H, Lindenborn H, Bangert A, Dahlhaus D, Albers P. Radiofrequency ablation of renal tumors improved by preoperative ex-vivo computer simulation model. J Endourol 2007; 21:886-90. [PMID: 17867947 DOI: 10.1089/end.2006.0458] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND AND PURPOSE Radiofrequency ablation (RFA) of small renal tumors has emerged as an option for patients with contraindications to surgery. The technique usually is limited to dorsolateral tumors because of the unknown pattern of heat distribution. The aim of this in-vitro experiment was to develop a planning computer simulation model of the heat distribution in order to calculate needle placement correctly. MATERIALS AND METHODS Our measurement system enables capture of the temperature pattern of a linear arrangement of thermocouples in a porcine cadaver kidney. A high-frequency sinusoidal electric current (460 kHz) was introduced via a unipolar umbrella-shaped needle electrode. The results of the RFA thermocoagulation were compared with the computer model using the finite element method. RESULTS Comparison between ex-vivo simulation and in-vivo measurement of destruction in three porcine cadaver kidneys showed excellent agreement. The discoloring of the necrotic region represented a temperature of 42 degrees C, where the tissue begins to denaturate. The 42 degrees C isodose temperature could be simulated precisely starting 6 mm from the center of the needle electrode. Using several MATLAB programs, simulation models were created to predict the space and time correlation of the necrotic regions. CONCLUSION This experimental model allows successful planning of the expected necrotic region using RFA in a cadaver kidney. Future planning can be improved by using a perfused in-vivo kidney model, thus allowing much more precise computer simulation before applying RFA to kidney tumors at critical locations.
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Affiliation(s)
- Michael Meyer
- Communications Lab, University of Kassel, Kassel, Germany
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Mouraviev V, Joniau S, Van Poppel H, Polascik TJ. Current Status of Minimally Invasive Ablative Techniques in the Treatment of Small Renal Tumours. Eur Urol 2007; 51:328-36. [PMID: 17069964 DOI: 10.1016/j.eururo.2006.09.024] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2006] [Accepted: 09/25/2006] [Indexed: 11/17/2022]
Abstract
OBJECTIVES In the current era, minimally invasive surgery using ablative techniques for the treatment of small renal tumours has become a more common and feasible treatment option. In this review, we present recent data regarding the utility of needle ablative techniques in the experimental and clinical settings. METHODS We performed a comprehensive evaluation of available published data from 1997 to 2006 that were identified with PubMed. Official proceedings of internationally known scientific societies held in the same time period were also assessed. RESULTS Two main thermoablative techniques, cryoablation (CA) and radiofrequency ablation (RFA), represent the current available minimally invasive treatments for renal cell carcinoma (RCC). CA has been more extensively studied and has gained acceptance from patients and physicians. The procedure is well tolerated by patients even with serious concomitant diseases. RFA is delivered with a monopolar alternating current. Morbidity rates for this modality remain slightly higher than those for cryotherapy. Both techniques are associated with highly successful cancer control rates at short-to-medium follow-up in patients with tumour size <3 cm. Multiple lesions can be treated simultaneously and the procedures can be repeated. However, long-term follow-up data are still lacking. CONCLUSION Minimally invasive ablative approaches seem to represent an attractive alternative to extirpative surgery for the treatment of small renal neoplasms in select patients. Potential developments include concepts to improve the accuracy of thermal ablation using novel imaging modalities with reduction in side-effects and optimised selection and follow-up of patients to provide at least equivalent cancer control to conventional surgery.
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Affiliation(s)
- Vladimir Mouraviev
- Division of Urologic Surgery, Department of Surgery, Duke University Medical Center, Durham, NC 27710, United States
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Permpongkosol S, Bagga HS, Romero FR, Sroka M, Jarrett TW, Kavoussi LR. Laparoscopic versus open partial nephrectomy for the treatment of pathological T1N0M0 renal cell carcinoma: a 5-year survival rate. J Urol 2007; 176:1984-8; discussion 1988-9. [PMID: 17070227 DOI: 10.1016/j.juro.2006.07.033] [Citation(s) in RCA: 106] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2005] [Indexed: 12/25/2022]
Abstract
PURPOSE We retrospectively compared the oncological adequacy of laparoscopic partial nephrectomy to that of open partial nephrectomy in the treatment of patients with pathological stage T1N0M0 renal cell carcinoma. MATERIALS AND METHODS A total of 143 patients with stage T1N0M0 renal tumors confirmed by pathological examination of the surgical specimen underwent partial nephrectomy between January 1996 and June 2004 with a followup of at least 1.5 years. Of these patients 85 were treated laparoscopically and the remaining 58 underwent open surgery. Medical and operative records were retrospectively reviewed with emphasis on tumor recurrence and survival. Statistical analysis was performed using Kaplan-Meier analysis. RESULTS The mean followup for the laparoscopy group was 40.4 +/- 18.0 months. A total of 83 patients survived. Of these patients 2 patients experienced disease recurrence within 18 to 46.2 months, 1 patient died of cancer metastasis to brain within 29.7 months and 1 died of an unrelated cause. Seeding of the port sites did not develop in any of the patients. The 5-year disease-free and actuarial survival rates for this group were 91.4%, and 93.8%, respectively. The 58 patients who underwent open surgery had a mean followup of 49.68 +/- 28.84 months. A total of 53 patients survived without any disease recurrence, 1 survived with recurrence within 8 months, 1 survived with metastasis within 49 months and 3 died of unrelated causes. The 5-year disease-free and patient survival rates for this group were 97.6% and 95.8%, respectively. Kaplan-Meier disease-free survival and patient survival analysis revealed no significant differences between the laparoscopic and open partial nephrectomy groups. CONCLUSIONS Laparoscopic partial nephrectomy is an alternative technique with mid-range oncological results comparable to open partial nephrectomy in patients with localized pathological stage T1N0M0 renal cell carcinoma.
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Affiliation(s)
- Sompol Permpongkosol
- The James Buchanan Brady Urological Institute, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
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Van Poppel H, Da Pozzo L, Albrecht W, Matveev V, Bono A, Borkowski A, Marechal JM, Klotz L, Skinner E, Keane T, Claessens I, Sylvester R. A prospective randomized EORTC intergroup phase 3 study comparing the complications of elective nephron-sparing surgery and radical nephrectomy for low-stage renal cell carcinoma. Eur Urol 2006; 51:1606-15. [PMID: 17140723 DOI: 10.1016/j.eururo.2006.11.013] [Citation(s) in RCA: 287] [Impact Index Per Article: 15.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2006] [Accepted: 11/03/2006] [Indexed: 02/08/2023]
Abstract
OBJECTIVES This study compared the complications and the cancer control of elective nephron-sparing surgery (NSS) and radical nephrectomy (RN) in patients with a small (<or=5 cm), solitary, low-stage N0 M0 tumour suspicious for renal cell carcinoma (RCC) and a normal contralateral kidney. METHODS 541 patients were randomised in a prospective, multicentre, phase 3 trial to undergo NSS (n=268) or RN (n=273) together with a limited lymph node dissection. RESULTS This publication reports only on the complications reported for both surgical methods. The rate of perioperative blood loss<0.5l was slightly higher after RN (96.0% vs. 87.2%) and the rate of severe haemorrhage was slightly higher after NSS (3.1% vs. 1.2%). Ten patients (4.4%), all of whom were treated with NSS, developed urinary fistulas. Pleural damage (11.5% for NSS vs. 9.3% for RN) and spleen damage (0.4% for NSS and 0.4% for RN) were observed with similar rates in both groups. Postoperative computed tomography scanning abnormalities were seen in 5.8% of NSS and 2.0% of RN patients. Reoperation for complications was necessary in 4.4% of NSS and 2.4% of RN patients. CONCLUSIONS NSS for small, easily resectable, incidentally discovered RCC in the presence of a normal contralateral kidney can be performed safely with slightly higher complication rates than after RN. The oncologic results are eagerly awaited to confirm that NSS is an acceptable approach for small asymptomatic RCC.
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Affiliation(s)
- Hendrik Van Poppel
- Department of Urology, University Hospital Gasthuisberg, Katholieke Universiteit Leuven, Leuven, Belgium.
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Abstract
The standard treatment for renal cell carcinoma for many years was radical nephrectomy, but in the past decade there has been a trend toward elective nephron-sparing surgery. Initially, partial nephrectomy was performed with an open surgical approach; more recently and with increasing frequency, a laparoscopic approach has been used in selected cases. Nephron-sparing surgery with either approach is more complex than is traditional radical nephrectomy and more frequently results in complications. The possible complications of partial nephrectomy include vascular, collecting system, and technical complications as well as recurrent tumor and infection. For prompt diagnosis and appropriate management of these complications, radiologists must be familiar with normal and abnormal features in the postoperative appearance of the kidney at computed tomography and magnetic resonance imaging.
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Affiliation(s)
- Gary M Israel
- Department of Radiology, Yale University School of Medicine, PO Box 208042, 333 Cedar St, New Haven, CT 06520-8042, USA.
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Joniau S, Vander Eeckt K, Van Poppel H. The indications for partial nephrectomy in the treatment of renal cell carcinoma. ACTA ACUST UNITED AC 2006; 3:198-205. [PMID: 16607368 DOI: 10.1038/ncpuro0458] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2005] [Accepted: 01/30/2006] [Indexed: 12/11/2022]
Abstract
Partial nephrectomy is performed more frequently for small, incidentally discovered, low-stage renal tumors. Importantly, one should distinguish the imperative indications for such surgery from the relative and elective indications, while taking contraindications to nephron-sparing surgery into account. The main advantage of partial nephrectomy over radical nephrectomy is the avoidance of renal insufficiency; the major disadvantages include the possibility of local recurrence and perioperative complications. In this article, the literature on nephron-sparing surgery was reviewed in order to put the management of renal cancer into a modern perspective.
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Affiliation(s)
- Steven Joniau
- Department of Urology, University Hospital Gasthuisberg, Leuven, Belgium
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Stojkovic I, Savic V, Djokic M, Balint B, Ljubenovic S, Ignjatovic I. Possibilities and Limitations of Fibrin Glue Usage in Nephron-Sparing Surgery: Experimental Study. Urol Int 2005; 74:355-60. [PMID: 15897704 DOI: 10.1159/000084438] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2003] [Accepted: 10/11/2004] [Indexed: 11/19/2022]
Abstract
INTRODUCTION The possibilities and limitations of fibrin glue (FG) usage in nephron-sparing surgery were studied. MATERIALS AND METHODS A prospective experimental study was carried out in 50 pigs: 30 with polar resection, and 20 with mediorenal wedge resection of the kidney. Hemostatic sutures, FG, and FG with a muscle 'cup' in animals with polar resection of the kidney were compared. FG and sutures in animals with the wedge resection of the kidney were studied as well. Bleeding, hot ischemia time, complication rate, and additional scarring were also analyzed. RESULTS Suture hemostasis is safe but with significant adverse effects in both polar and wedge resection of kidney. FG was not efficient as a sole hemostatic agent for polar resection. It was as efficient as hemostatic suture for wedge resection of the kidney. FG with a muscle 'cup' on a pole of the kidney achieved good results in animals with polar resection of the kidney. Histological analysis confirmed better results with FG because of both the less intense and smaller area of additional scarring. CONCLUSION FG is a reliable and efficient hemostatic agent for nephron-sparing surgery whenever both sided gluing is possible.
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Affiliation(s)
- Ivica Stojkovic
- Clinic of Urology, Clinical Center Nis, Nis, Serbia and Montenegro
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Heye S, Maleux G, Van Poppel H, Oyen R, Wilms G. Hemorrhagic Complications After Nephron-Sparing Surgery: Angiographic Diagnosis and Management by Transcatheter Embolization. AJR Am J Roentgenol 2005; 184:1661-4. [PMID: 15855135 DOI: 10.2214/ajr.184.5.01841661] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Nephron-sparing surgery has become an accepted treatment technique for renal cell carcinoma in properly selected patients. Although rare, major postoperative hemorrhage can occur and is usually accompanied by gross hematuria with or without acute flank pain at the site of prior surgery. In this retrospective study, the immediate radiologic and clinical success and the long-term follow-up of transcatheter embolization are evaluated. CONCLUSION Transcatheter selective embolization is a safe and effective technique for appropriate management of this postoperative vascular complication.
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Affiliation(s)
- Sam Heye
- Department of Radiology, University Hospitals Gasthuisberg, Herestraat 49, Leuven B-3000, Belgium.
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Inoue Y, Kurimoto S, Kameyama S, Ohta N, Akahane M, Yoshikawa K, Yokoyama I, Minami M, Ohtomo K, Kitamura T. Prolonged renal parenchymal retention of 99mTc mercaptoacetyltriglycine after nephron-sparing surgery. Nucl Med Commun 2004; 25:509-13. [PMID: 15100511 DOI: 10.1097/00006231-200405000-00013] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Nephron-sparing surgery is a treatment in which a part of a diseased kidney is resected and some parenchyma of the kidney is spared. Impairment of spared renal parenchyma after the surgery may cause prolonged prarenchymal retention in renal scintigraphy with Tc mercaptoacetyltriglycine (Tc-MAG3). The aim of this study was to determine whether or not parenchymal retention of Tc-MAG3 is prolonged after nephron-sparing surgery. METHODS Twenty-two patients underwent a total of 29 Tc-MAG3 studies within 1 year after nephron-sparing surgery. In 17 patients (23 examinations) who had bilateral kidneys, the presence of diffuse prolongation of parenchymal retention was determined for the operated kidney. In all patients, the presence of regional prolongation around the surgical margin was assessed. RESULTS Diffuse prolongation was observed in four of 10 examinations performed within 1 month after surgery and in none of 13 examinations performed later than 1 month after surgery. Regional prolongation was shown in 10 of 14 examinations performed within 1 month after surgery and in three of 15 examinations performed later than 1 month after surgery. In five patients who were studied both prior to and later than 1 month after surgery, regional prolongation was noted on the first study. On the second study, regional prolongation was improved and initial renal uptake around the surgical margin was intensified. CONCLUSIONS Renal parenchymal retention of Tc-MAG3 is frequently prolonged in the early period after nephron-sparing surgery. Renal scintigraphy with Tc-MAG3 may aid in characterizing acute renal damage after nephron-sparing surgery.
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Affiliation(s)
- Yusuke Inoue
- Department of Radiology, Institute of Medical Science, Graduate School of Medicine, University of Tokyo, 4-6-1 Shirokanedai, Minato-ku, Tokyo 108-8639, Japan.
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Roy-Choudhury SH, Cast JEI, Cooksey G, Puri S, Breen DJ. Early experience with percutaneous radiofrequency ablation of small solid renal masses. AJR Am J Roentgenol 2003; 180:1055-61. [PMID: 12646454 DOI: 10.2214/ajr.180.4.1801055] [Citation(s) in RCA: 69] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Incidental small renal-cell masses are often seen in elderly patients with significant comorbidity who are unfit to undergo major surgery. This study was conducted to determine the safety and efficacy of percutaneous imaging-guided radiofrequency ablation in the management of small solid renal masses, almost all of which are renal cell cancers. CONCLUSION Early experience suggests that radiofrequency ablation is a safe, well-tolerated, and minimally invasive therapy for patients with solid renal masses. In the era of nephron-sparing surgery, radiofrequency ablation may have a role in the management of small problematic renal masses.
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Affiliation(s)
- Shuvro H Roy-Choudhury
- Department of Radiology, Hull and East Yorkshire Hospitals NHS Trust, Anlaby Rd., Kingston Upon Hull, HU3 2JZ, United Kingdom
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RE: LAPAROSCOPIC RADICAL NEPHRECTOMY: CANCER CONTROL FOR RENAL CELL CARCINOMA. J Urol 2002. [DOI: 10.1097/00005392-200209000-00059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Russo P. Re: laparoscopic radical nephrectomy: cancer control for renal cell carcinoma. J Urol 2002; 168:1109; author reply 1109-10. [PMID: 12187242 DOI: 10.1016/s0022-5347(05)64596-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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