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Han DS, Johnson JP, Schulster ML, Shah O. Indications for and results of renal autotransplantation. Curr Opin Nephrol Hypertens 2023; 32:183-192. [PMID: 36683544 DOI: 10.1097/mnh.0000000000000860] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
PURPOSE OF REVIEW To understand the indications and outcomes of renal autotransplantation, and when to consider this unique procedure for patients. RECENT FINDINGS Renal autotransplantation confers acceptably low rates of graft failure and prevents need for long-term dialysis. Renal autotransplantation remains an important management strategy in very select patients for complex renovascular disease, ureteral stricture disease, ureteral trauma, upper urinary tract urothelial carcinoma, renal cell carcinoma, and Loin-Pain Hematuria Syndrome. With advancements in minimally invasive procedures, the application of renal autotransplantation for refractory stone disease is rare but exists. Robot-assisted laparoscopic renal autotransplantation demonstrates reproducible graft success and complication rates with improved perioperative outcomes (ex. hospital length of stay) - though comparative studies are lacking. Patients would benefit from a multidisciplinary approach from renal transplant surgeons, vascular surgeons, urologists, nephrologists, dieticians, pain management providers, social workers, and psychiatrists. SUMMARY In experienced hands, renal autotransplantation is a reasonable treatment approach for complex and refractory renal vascular disease, Loin-Pain Hematuria Syndrome, ureteral strictures and trauma, upper urinary tract malignancy, and stone disease in highly select patients.
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Affiliation(s)
- David S Han
- Columbia University Irving Medical Center, Department of Urology
| | - Jeffrey P Johnson
- Weill Cornell Medical College, Department of Urology, New York, New York, USA
| | | | - Ojas Shah
- Columbia University Irving Medical Center, Department of Urology
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2
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Cheng SD, Li WQ, Mu L, Ding GP, Zhang B, Shen C, Ying ZW, Yang KL, Hao H, Li XS, Zhou LQ. [Application of totally extraperitoneal renal autotransplantation with Boari flap-pelvis anastomosis in upper urinary tract urothelial carcinomas treatment]. JOURNAL OF PEKING UNIVERSITY. HEALTH SCIENCES 2019; 51:758-763. [PMID: 31420636 DOI: 10.19723/j.issn.1671-167x.2019.04.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To evaluate the feasibility and effectiveness of the totally extraperitoneal renal autotransplantation with boari flap-pelvis anastomosis in the treatment of upper urinary tract urothelial carcinoma (UTUC), and to review the experience of renal autotransplantation for UTUC treatment. METHODS One case of applying the totally extraperitoneal renal autotransplantation with boari flap-pelvis anastomosis to the UTUC treatment was reported, and related literature was reviewed. The patient was a sixty-four-year old man who received right radical nephroureterectomy for right ureteral carcinoma 1 year before and diagnosed as left ureteral carcinoma(G2, high grade) this time. In order to preserve his renal function and avoid the shortness of common kidney-sparing surgery, a totally extraperitoneal procedure, including retroperitoneoscopic nephrectomy, ureterectomy, renal autotransplantation and Boari flap-pelvis anastomosis, was performed to the patient. RESULTS The operation was completed successfully without perioperative complications. The renal function recovered to preoperative level within 1 week. No deterioration of renal function during the follow-up and no tumor recurrence was observed under cystoscopy at the 3-month postoperative consult. CONCLUSION The totally extraperitoneal renal autotransplantation with Boari flap-pelvis anastomosis is a feasible and effective treatment for UTUC. The innovative procedure has several advantages compared to the former ones. The extraperitoneal procedure results in significantly less pain, shorter hospital stay, decreased overall time to recovery and lower bowel complications risk without warm ischemia time extension. Meanwhile, the Boari flap-pelvis anastomosis simplifies the follow -up protocols and creates an easy route for cystoscopy and topical therapy. From the systematic clinical analysis, as well as the related literature review, it's been concluded that the renal autotransplantation can be a reasonable option for the patients who have UTUC in solitary kidney or have bilateral UTUC. This type of treatment possesses advantages of preservation of renal function and total resection of malignant lesions. But long-term data and large cohort study on renal function or tumor recurrence are still absent which will be necessary to confirm the advantages of this approach.
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Affiliation(s)
- S D Cheng
- Department of Urology, Peking University First Hospital; Institute of Urology, Peking University; National Urological Cancer Center, Beijing 100034, China
| | - W Q Li
- Department of Urology, The First College of Clinical Medical Science, China Three Gorges University/Yichang Central People's Hospital, Yichang 443003, Hubei, China
| | - L Mu
- Central Operating Room, Peking University First Hospital, Beijing 100034, China
| | - G P Ding
- Department of Urology, Peking University First Hospital; Institute of Urology, Peking University; National Urological Cancer Center, Beijing 100034, China
| | - B Zhang
- Department of Urology, Peking University First Hospital; Institute of Urology, Peking University; National Urological Cancer Center, Beijing 100034, China
| | - C Shen
- Department of Urology, Peking University First Hospital; Institute of Urology, Peking University; National Urological Cancer Center, Beijing 100034, China
| | - Z W Ying
- Department of Urology, Peking University First Hospital; Institute of Urology, Peking University; National Urological Cancer Center, Beijing 100034, China
| | - K L Yang
- Department of Urology, Peking University First Hospital; Institute of Urology, Peking University; National Urological Cancer Center, Beijing 100034, China
| | - H Hao
- Department of Urology, Peking University First Hospital; Institute of Urology, Peking University; National Urological Cancer Center, Beijing 100034, China
| | - X S Li
- Department of Urology, Peking University First Hospital; Institute of Urology, Peking University; National Urological Cancer Center, Beijing 100034, China
| | - L Q Zhou
- Department of Urology, Peking University First Hospital; Institute of Urology, Peking University; National Urological Cancer Center, Beijing 100034, China
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Ou YC, Hu CY, Cheng HL, Yang WH. Long-term outcomes of total ureterectomy with ileal-ureteral substitution treatment for ureteral cancer: a single-center experience. BMC Urol 2018; 18:73. [PMID: 30170590 PMCID: PMC6119331 DOI: 10.1186/s12894-018-0389-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Accepted: 08/24/2018] [Indexed: 11/26/2022] Open
Abstract
Background To explore the feasibility and long-term outcomes of renal preservation in a retrospective cohort of patients with ureteral urothelial carcinoma undergoing total ureterectomy with ileal-ureteral substitution. Methods A retrospective review of the data from patients treated with total ureterectomy with ileal-ureteral substitution from 1988 to 2016 was performed. The pre-operative oncological status, long-term oncological outcome, long-term renal functional outcome, early and late complications were analyzed. Results A total of eight patients with a median age of 70 years were included. The median follow-up time was 109 months. Six patients had multi-focal tumor involvement over the target ureter, and six patients had bilateral upper tract involvement. Only one patient encountered the upper-tract recurrence. The 2 and 5-year cancer-specific survival rates were 87.5 and 75.0%, respectively. The renal function was well-preserved in most patients, with only one patient needed life-long postoperative hemodialysis. Five patients experienced early complications and four patients experienced late complications. No perioperative mortality happened. Conclusions A total ureterectomy with an ileal-ureteral substitution is feasible for treating ureteral urothelial carcinoma when a renal-sparing procedure is indicated. It provides good long-term oncological outcomes over the upper tract, and it also preserves the renal function.
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Affiliation(s)
- Yin-Chien Ou
- Department of Urology, National Cheng Kung University Hospital, No.138, Sheng Li Road, Tainan, 704, Taiwan, Republic of China
| | - Che-Yuan Hu
- Department of Urology, National Cheng Kung University Hospital, No.138, Sheng Li Road, Tainan, 704, Taiwan, Republic of China
| | - Hong-Lin Cheng
- Department of Urology, National Cheng Kung University Hospital, No.138, Sheng Li Road, Tainan, 704, Taiwan, Republic of China
| | - Wen-Horng Yang
- Department of Urology, National Cheng Kung University Hospital, No.138, Sheng Li Road, Tainan, 704, Taiwan, Republic of China.
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Experience with Renal Autotransplantation: Typical and Atypical Indications. Adv Urol 2018; 2018:3404587. [PMID: 29780413 PMCID: PMC5892291 DOI: 10.1155/2018/3404587] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Revised: 02/18/2018] [Accepted: 02/21/2018] [Indexed: 12/02/2022] Open
Abstract
Introduction and Objectives Renal autotransplantation is a kidney-saving surgical procedure used in selected patients. The purpose of this report is to review nine typical and atypical indications for kidney autotransplantation and evaluate its effectiveness in maintaining kidney function and avoiding cancer recurrence. Materials and Methods From 1999 till 2014, nine renal autotransplantations were performed in our center. A retrospective case review was done. Four of nine patients had a solitary functioning kidney. Typical indications for autotransplantation included extended ureteric disease in 5 patients, intrasinusal tumor on a solitary kidney in 1 patient, and renal artery aneurysm in 1 patient. Atypical indications consisted in bilateral urothelial tumors in 1 patient and interrupted live kidney transplantation in 1 patient. Mean cold ischemia time was 209 minutes. Demographic factors, indications, renal function before and after surgery, and in the long term, cancer recurrence and disease-free survival were evaluated. Results Renal function was maintained in 8 patients during the early follow-up. No serious complications occurred in the postoperative period. Median duration of follow-up was 50 months. In 4 patients with a normal contralateral kidney, mean preoperative and at discharge creatinine clearance were 105.45 ml/min and 121.02 ml/min, respectively. Although values showed an improvement in the kidney function, the difference was not significant (p value 0.3). In the other 4 patients with a solitary kidney, mean discharge creatinine clearance was 99.24 ml/min surprisingly higher than the preoperative value 96.92 ml/min. At the last follow-up, kidney function was preserved for the two groups (normal contralateral kidney/solitary kidney) with relatively stable creatinine clearance values: 108.45 ml/min and 85.9 ml/min, respectively. No patients required secondary dialysis. Conclusion Renal autotransplantation is a rare, safe, and effective surgical procedure for the treatment of complex urologic conditions. In some instances, it may be of great utility for kidney salvage in some carefully selected patients.
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Papatsoris AG, Chrisofos M, Skolarikos A, Varkarakis I, Lekas A, Dellis A, Koritsiadis S, Deliveliotis C. Upper Urinary Tract Transitional Cell Carcinoma. A 10-year Experience. TUMORI JOURNAL 2018; 94:75-8. [DOI: 10.1177/030089160809400114] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective To present our 10-year experience with patients surgically treated for upper urinary tract transitional cell carcinoma. Patients and methods We reviewed the medical records of 264 patients (218 males and 46 females), aged 37–93 years (mean, 69.5), treated surgically for upper tract transitional cell carcinoma during the period January 1996 to December 2005. Results During the mean follow-up of 58 months (range, 12–120), local relapse was diagnosed in 14% of the patients. The mean time to recurrence was 13 months (range, 1–102). The overall mortality was 14%, and the mean survival was 109 months. Survival was significantly influenced by the following parameters: male gender (P = 0.0151), age over 80 years (P = 0.0012), location in both the pelviocaliceal system and the ureter (P = 0.051), a two incision operation (P = 0.0075), grade III (P = 0.0314), stage T3 and T4 (P <0.0001). Conclusions Tumor stage was identified as the most important determinant in predicting recurrence and survival. Other predictors of survival included male gender, age over 80 years, location in the pelviocaliceal system and the ureter, a two incision operation, and high grade.
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Affiliation(s)
- Athanasios G Papatsoris
- Second Department of Urology, School of Medicine, University of Athens, Sismanoglio Hospital, Athens
| | - Michael Chrisofos
- Second Department of Urology, School of Medicine, University of Athens, Sismanoglio Hospital, Athens
| | - Andreas Skolarikos
- Second Department of Urology, School of Medicine, University of Athens, Sismanoglio Hospital, Athens
| | - Ioannis Varkarakis
- Second Department of Urology, School of Medicine, University of Athens, Sismanoglio Hospital, Athens
| | - Alexandros Lekas
- Department of Urology, General Hospital of Nikea, Piraeus, Greece
| | - Athanasios Dellis
- Second Department of Urology, School of Medicine, University of Athens, Sismanoglio Hospital, Athens
| | | | - Charalambos Deliveliotis
- Second Department of Urology, School of Medicine, University of Athens, Sismanoglio Hospital, Athens
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Woods T, Jennings NB, Fernandez HT, Onaca N, Carlile BK, Levy MF, Gould DL, Ruiz R. Renal Autotransplantation in Lynch Syndrome: A Viable Option in a Patient With Contralateral Metachronous Ureteral Cancer. Am J Transplant 2015; 15:2507-10. [PMID: 25847116 DOI: 10.1111/ajt.13279] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2015] [Revised: 02/18/2015] [Accepted: 02/22/2015] [Indexed: 01/25/2023]
Abstract
The success of human kidney allotransplantation was realized over six decades ago. First described 50 years ago, renal autotransplantation has been utilized sparingly as a salvage procedure for patients at risk of losing renal function, either from a benign or malignant condition. While classically associated with colorectal malignancies, Lynch syndrome also carries a small yet significant risk for the development of ureteral carcinoma. For these patients who develop chronic kidney disease, allotransplantation may not be an option due to the lifelong risk of several malignancies. We report the first known case of renal autotransplantation in a patient with metachronous ureteral cancer due to Lynch syndrome.
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Affiliation(s)
- T Woods
- Annette C. and Harold C. Simmons Transplant Institute, Baylor All Saints Medical Center at Fort Worth, Fort Worth, TX
| | - N B Jennings
- Annette C. and Harold C. Simmons Transplant Institute, Baylor All Saints Medical Center at Fort Worth, Fort Worth, TX
| | - H T Fernandez
- Annette C. and Harold C. Simmons Transplant Institute, Baylor All Saints Medical Center at Fort Worth, Fort Worth, TX
| | - N Onaca
- Annette C. and Harold C. Simmons Transplant Institute, Baylor All Saints Medical Center at Fort Worth, Fort Worth, TX
| | - B K Carlile
- Annette C. and Harold C. Simmons Transplant Institute, Baylor All Saints Medical Center at Fort Worth, Fort Worth, TX
| | - M F Levy
- Annette C. and Harold C. Simmons Transplant Institute, Baylor All Saints Medical Center at Fort Worth, Fort Worth, TX
| | - D L Gould
- Annette C. and Harold C. Simmons Transplant Institute, Baylor All Saints Medical Center at Fort Worth, Fort Worth, TX
| | - R Ruiz
- Annette C. and Harold C. Simmons Transplant Institute, Baylor All Saints Medical Center at Fort Worth, Fort Worth, TX
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Cheng YT, Flechner SM, Chiang PH. The role of laparoscopy-assisted renal autotransplantation in the treatment of primary ureteral tumor. Ann Surg Oncol 2015; 21:3691-7. [PMID: 25015030 DOI: 10.1245/s10434-013-3382-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2013] [Indexed: 01/04/2023]
Abstract
BACKGROUND To evaluate the effect and safety of laparoscopy-assisted renal autotransplantation treatment for primary ureteral cancer (PUC). METHODS Medical records of patients undergoing hand-assisted retroperitoneoscopic nephroureterectomy–extracorporeal total ureterectomy–renal autotransplantation–pyelocystostomy (Lap AutoTx) were analyzed. Demographic, intraoperative, and postoperative data were assessed. RESULTS Fifteen patients diagnosed with PUC underwent this novel approach. Three kidneys were abandoned owing to the detection of residual cancer on the renal pelvic junction, surgeon’s judgment on three severe atherosclerotic arteries, and palpable pelvic lymph nodes proven to be evidence of metastatic disease by frozen section analysis. Twelve patients (mean ± SD age 67.5 ± 7.5 years) were treated with Lap AutoTx for PUC successfully. No perioperative mortality occurred. One patient with solitary kidney experienced delayed graft function that required short-term hemodialysis. Three recurrent superficial diseases in three patients were treated with transurethral resection. The mean ± SD follow-up duration was 12.1 ± 6.7 months (range 3–24 months). The renal pelvicaliceal system was easily examined by flexible cystoscopy. CONCLUSIONS Lap AutoTx is less invasive compared with the traditional two-incisional manner and can be performed safely even among elderly patients. Compared with other currently used therapies, this novel treatment can be used to successfully treat PUC with the added advantages of total resection of the ureteral lesion, preservation of the renal function, and simplification of follow-up procedures.Primary ureteral cancer (PUC) is an aggressive disease and has a poor prognosis.1 Studies have shown high prevalence and invasiveness of PUC in Taiwan.2,3 Nephroureterectomy with excision of the bladder cuff is still believed to be the gold standard treatment for PUC.4 Most PUC occurs among individuals aged more than 60 years, and most of these patients are also at high risk of chronic kidney disease (CKD).5,6 Nephroureterectomy not only results in excessive loss of renal function, but also puts the patient at risk of CKD, which contributes to the progression of end-stage renal disease requiring dialysis. In addition, diminished renal function after nephroureterectomy compromises the possible use of adjuvant chemotherapy for advanced disease.Endoscopic surgery (ES) and segmental resection (SR) can be used for renal preservation in PUC cases, but there still are limitations to these approaches, and indefinite invasive ureteroscopy is required during follow-up. Only a few studies have focused on renal autotransplantation (AutoTx) after extracorporeal total ureterectomy (ETU) for PUC. This type of treatment possesses advantages of total resection of malignant ureteral lesions, preservation of renal function, and simplification of follow-up protocols. In two reported case series, all cases involved surgery performed with the traditional 2-incision approach, and only a few cases involved pure PUC.7,8 We have reported that hand-assisted retroperitoneoscopic nephroureterectomy (HARNU) for the treatment of PUC is less invasive and results in better functional outcomes with fewer complications and comparable oncologic control compared with open nephroureterectomy.9 In this study, we report our experience of this treatment combined with ETU and AutoTx for pure PUC.
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8
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Sood A, Jeong W, Ahlawat R, Abdollah F, Sammon JD, Bhandari M, Menon M. Minimally invasive renal autotransplantation. J Surg Oncol 2015; 112:717-22. [PMID: 25995142 DOI: 10.1002/jso.23939] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2015] [Accepted: 04/30/2015] [Indexed: 12/11/2022]
Abstract
Minimally invasive renal allotransplantation techniques have been recently described; reported benefits include reduced morbidity/complications. These benefits have been successfully adapted for minimally invasive renal autotransplantation, however, in a non-oncological setting. We, here, describe a novel alternative robot-assisted renal autotransplantation technique, utilizing GelPOINT, which by permitting ex vivo graft examination and surgery might allow further broadening of indications for minimally-invasive renal autotransplantation, to include complex oncological renal/ureteral lesions. Future studies are needed to evaluate the utility of these techniques.
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Affiliation(s)
- Akshay Sood
- Vattikuti Urology Institute, Henry Ford Health System, Detroit, Michigan
| | - Wooju Jeong
- Vattikuti Urology Institute, Henry Ford Health System, Detroit, Michigan
| | - Rajesh Ahlawat
- Kidney and Urology Institute, Medanta-The Medicity, Gurgaon, India
| | - Firas Abdollah
- Vattikuti Urology Institute, Henry Ford Health System, Detroit, Michigan
| | - Jesse D Sammon
- Vattikuti Urology Institute, Henry Ford Health System, Detroit, Michigan
| | - Mahendra Bhandari
- Vattikuti Urology Institute, Henry Ford Health System, Detroit, Michigan
| | - Mani Menon
- Vattikuti Urology Institute, Henry Ford Health System, Detroit, Michigan
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Huang LH, Hung SW, Ou YC, Chiu KY. Nephron-sparing surgery with autotransplantation for high-grade upper urinary tract urothelial carcinoma in a patient with solitary kidney. UROLOGICAL SCIENCE 2014. [DOI: 10.1016/j.urols.2013.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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10
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Bench surgery with renal autotransplantation for angiomyolipoma of renal sinus. Transplant Proc 2014; 46:1281-5. [PMID: 24935290 DOI: 10.1016/j.transproceed.2014.01.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2013] [Revised: 12/16/2013] [Accepted: 01/15/2014] [Indexed: 11/22/2022]
Abstract
BACKGROUND The treatment of angiomyolipomas (AML) of the renal sinus is challenging and often requires nephrectomy. In this study, we report on 5 patients who underwent extracorporeal AML resection and subsequent renal autotransplantation (RA) for renal sinus AML. METHODS As of May 2013, 5 patients had undergone extracorporeal AML resection and RA for renal sinus AML at our institute. Separation of the AML in renal sinus is performed by combined sharp and blunt dissection. Tissue between AML and renal sinus is ligated where blood vessels cannot be excluded. When complicated with AML of the renal parenchyma, the AMLs were resected using ultrasound guidance. RESULTS Renal nuclear scan showed that kidney grafts were perfused uniformly without evidence of segmental infarction at day 7 posttransplantation in all patients. No significant deterioration in renal function and tumor recurrence was noted over a median follow-up of 3 months (range: 1 to 6 months). All patients presented with normal blood pressure values. No intraoperative complications occurred. CONCLUSIONS Bench surgery and subsequent RA method, due to its advantage of kidney preservation, is a valuable option for renal sinus AML treatment.
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Iida T, Kawa G, Matsuda T. A case of preserving renal function by renal autotransplantation for bilateral urothelial carcinoma of the ureter. Int J Urol 2009; 16:587. [DOI: 10.1111/j.1442-2042.2009.02310.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Eisenberg ML, Lee KL, Zumrutbas AE, Meng MV, Freise CE, Stoller ML. Long-term outcomes and late complications of laparoscopic nephrectomy with renal autotransplantation. J Urol 2007; 179:240-3. [PMID: 18001789 DOI: 10.1016/j.juro.2007.08.135] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2007] [Indexed: 12/11/2022]
Abstract
PURPOSE We report long-term outcomes and late complications after laparoscopic nephrectomy with autotransplantation. MATERIALS AND METHODS We retrospectively reviewed clinical data on all patients who underwent laparoscopic nephrectomy with autotransplantation between July 2000 and March 2007. Late complications, ie greater than 6 months, that required surgical intervention were analyzed. Clinical outcomes in patients with primary ureteral stricture disease and oncological outcomes in patients with renal tumors were examined. RESULTS Indications for autotransplantation included complex ureteral stricture disease in 15 patients and renal malignancy in 4. Median age at surgery was 48 years (range 25 to 68). Median followup was 29 months. Of the 17 patients with greater than 6 months of followup late complications requiring surgical intervention occurred in 4. Transplant nephrectomy was required in 2 patients in the stricture group. Indications for nephrectomy were nonfunction complicated by pseudoaneurysm in 1 case and chronic loin pain in 1. Another patient had recurrent nephrolithiasis requiring percutaneous nephrolithotomy and in 1 a pseudoaneurysm was managed successfully by endovascular techniques. Two patients in the tumor group had disease progression, which was managed medically. CONCLUSIONS Given the complexity and severity of disease that necessitates renal autotransplantation, it is not surprising that additional treatments are required. Patients with primary stricture disease may be at increased risk for vascular aneurysm due to infection and/or inflammation. Tumor progression is possible after ex vivo tumor excision and autotransplantation, especially in patients requiring heroic measures to avoid or delay dialysis. Thus, careful patient selection and vigilant followup are mandatory.
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Affiliation(s)
- Michael L Eisenberg
- Department of Urology, University of California-San Francisco, San Francisco, California 94143-0738, USA
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Krambeck AE, Thompson RH, Lohse CM, Patterson DE, Elliott DS, Blute ML. Imperative Indications for Conservative Management of Upper Tract Transitional Cell Carcinoma. J Urol 2007; 178:792-6; discussion 796-7. [PMID: 17632132 DOI: 10.1016/j.juro.2007.05.056] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2007] [Indexed: 11/22/2022]
Abstract
PURPOSE We report our experience with patients with imperative indications for endoscopic treatment for upper tract transitional cell carcinoma. MATERIALS AND METHODS Between 1983 and 2004 we identified 37 patients with a solitary kidney, bilateral disease or preoperative creatinine greater than 2.0 mg/dl who underwent endoscopic treatment for localized upper tract transitional cell carcinoma. A retrospective chart review was performed. RESULTS Of the 37 patients 32 had a solitary kidney, 3 had bilateral disease and 2 had preoperative creatinine greater than 2.0 mg/dl. Median age at diagnosis was 75 years (range 56 to 88). Bladder cytology was positive or atypical in 15 of 31 patients (48%). Tumors were grade 1 to 3 in 2, 13 and 7 patients, respectively, and diagnosed visually in 15. At a median followup of 2.7 years for survivors 23 patients (62%) had a total of 56 upper tract transitional cell carcinoma recurrences. Grade and stage progression occurred in 3 and 3 patients, respectively. Ten of the 23 patients who experienced upper tract recurrence died of transitional cell carcinoma. Overall kidney preservation was achieved in 24 of the 32 patients (75%) with a solitary kidney. At last followup 24 patients had died, including 11 (29.7%) of transitional cell carcinoma, at a median of 2.9 years. Cancer specific survival at 5 years for this cohort was 49.3%. CONCLUSIONS Our results indicate that upper tract tumor recurrence occurs in a majority of patients with imperative indications for endoscopic treatment, underscoring the need for frequent surveillance. While most kidneys can be preserved, cancer specific death is common.
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Affiliation(s)
- Amy E Krambeck
- Department of Urology, Mayo Medical School and Mayo Clinic, Rochester, Minnesota 55905, USA.
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