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Liu J, Zhang B, Qi P, Ren X, Zheng D, He Y, Zheng X, Yue Z, Li Y, Yang N, Wang Z, Bao J, Tian J, Yang L, Zhai Z, Zuo L, Hou Z, Wang J, Wang W, Chang H, Ma J, Zhang Y, Dong Z, Dong Z, Zhong G, Cheng H, Lei P, Li Z, Wu G, Shang P. Transperitoneal vs retroperitoneal laparoscopic radical nephrectomy: a double-arm, parallel-group randomized clinical trial. BMC Urol 2024; 24:29. [PMID: 38310213 PMCID: PMC10838419 DOI: 10.1186/s12894-023-01364-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 11/09/2023] [Indexed: 02/05/2024] Open
Abstract
OBJECTIVE To compare the outcomes of patients undergoing Retroperitoneal laparoscopic Radical nephrectomy (RLRN) and Transperitoneal laparoscopic Radical nephrectomy (TLRN). METHODS A total of 120 patients with localized renal cell carcinoma were randomized into either RLRN or TLRN group. Mainly by comparing the patient perioperative related data, surgical specimen integrity, pathological results and tumor results. RESULTS Each group comprised 60 patients. The two group were equivalent in terms of perioperative and pathological outcomes. The mean integrity score was significantly lower in the RLRN group than TLRN group. With a median follow-up of 36.4 months after the operation, Kaplan-Meier survival analysis showed no significant difference between RLRN and TLRN in overall survival (89.8% vs. 88.5%; P = 0.898), recurrence-free survival (77.9% vs. 87.7%; P = 0.180), and cancer-specific survival (91.4% vs. 98.3%; P = 0.153). In clinical T2 subgroup, the recurrence rate and recurrence-free survival in the RLRN group was significantly worse than that in the TLRN group (43.2% vs. 76.7%, P = 0.046). Univariate and multivariate COX regression analysis showed that RLRN (HR: 3.35; 95%CI: 1.12-10.03; P = 0.030), male (HR: 4.01; 95%CI: 1.07-14.99; P = 0.039) and tumor size (HR: 1.23; 95%CI: 1.01-1.51; P = 0.042) were independent risk factor for recurrence-free survival. CONCLUSIONS Our study showed that although RLRN versus TLRN had roughly similar efficacy, TLRN outperformed RLRN in terms of surgical specimen integrity. TLRN was also significantly better than RLRN in controlling tumor recurrence for clinical T2 and above cases. TRIAL REGISTRATION Chinese Clinical Trial Registry ( https://www.chictr.org.cn/showproj.html?proj=24400 ), identifier: ChiCTR1800014431, date: 13/01/2018.
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Affiliation(s)
- Junyao Liu
- Department of Urology, Lanzhou University Second Hospital, No.82 Cui Ying Gate, Cheng Guan District, Lanzhou, 730030, Gansu, China
| | - Bin Zhang
- Department of Urology, Lanzhou University Second Hospital, No.82 Cui Ying Gate, Cheng Guan District, Lanzhou, 730030, Gansu, China
| | - Peng Qi
- Department of Urology, Lanzhou University Second Hospital, No.82 Cui Ying Gate, Cheng Guan District, Lanzhou, 730030, Gansu, China
| | - Xiaowei Ren
- School of Public Health, Lanzhou University, Lanzhou, Gansu, China
| | - Duo Zheng
- Department of Urology, Lanzhou University Second Hospital, No.82 Cui Ying Gate, Cheng Guan District, Lanzhou, 730030, Gansu, China
| | - Yang He
- Department of Urology, Lanzhou University Second Hospital, No.82 Cui Ying Gate, Cheng Guan District, Lanzhou, 730030, Gansu, China
| | - Xu Zheng
- Department of Urology, Lanzhou University Second Hospital, No.82 Cui Ying Gate, Cheng Guan District, Lanzhou, 730030, Gansu, China
| | - Zhongjin Yue
- Department of Urology, Lanzhou University Second Hospital, No.82 Cui Ying Gate, Cheng Guan District, Lanzhou, 730030, Gansu, China
| | - Ye Li
- Department of Urology, Lanzhou University Second Hospital, No.82 Cui Ying Gate, Cheng Guan District, Lanzhou, 730030, Gansu, China
| | - Ningqiang Yang
- Department of Urology, Lanzhou University Second Hospital, No.82 Cui Ying Gate, Cheng Guan District, Lanzhou, 730030, Gansu, China
| | - Zhiping Wang
- Department of Urology, Lanzhou University Second Hospital, No.82 Cui Ying Gate, Cheng Guan District, Lanzhou, 730030, Gansu, China
| | - Junsheng Bao
- Department of Urology, Lanzhou University Second Hospital, No.82 Cui Ying Gate, Cheng Guan District, Lanzhou, 730030, Gansu, China
| | - Junqiang Tian
- Department of Urology, Lanzhou University Second Hospital, No.82 Cui Ying Gate, Cheng Guan District, Lanzhou, 730030, Gansu, China
| | - Li Yang
- Department of Urology, Lanzhou University Second Hospital, No.82 Cui Ying Gate, Cheng Guan District, Lanzhou, 730030, Gansu, China
| | - Zhenxing Zhai
- Department of Urology, Lanzhou University Second Hospital, No.82 Cui Ying Gate, Cheng Guan District, Lanzhou, 730030, Gansu, China
| | - Lingjun Zuo
- Department of Urology, Lanzhou University Second Hospital, No.82 Cui Ying Gate, Cheng Guan District, Lanzhou, 730030, Gansu, China
| | - Zizhen Hou
- Department of Urology, Lanzhou University Second Hospital, No.82 Cui Ying Gate, Cheng Guan District, Lanzhou, 730030, Gansu, China
| | - Jiaji Wang
- Department of Urology, Lanzhou University Second Hospital, No.82 Cui Ying Gate, Cheng Guan District, Lanzhou, 730030, Gansu, China
| | - Wei Wang
- Department of Urology, Lanzhou University Second Hospital, No.82 Cui Ying Gate, Cheng Guan District, Lanzhou, 730030, Gansu, China
| | - Hong Chang
- Department of Urology, Lanzhou University Second Hospital, No.82 Cui Ying Gate, Cheng Guan District, Lanzhou, 730030, Gansu, China
| | - Junhai Ma
- Department of Urology, Lanzhou University Second Hospital, No.82 Cui Ying Gate, Cheng Guan District, Lanzhou, 730030, Gansu, China
| | - Yunxin Zhang
- Department of Urology, Lanzhou University Second Hospital, No.82 Cui Ying Gate, Cheng Guan District, Lanzhou, 730030, Gansu, China
| | - Zhichun Dong
- Department of Urology, Lanzhou University Second Hospital, No.82 Cui Ying Gate, Cheng Guan District, Lanzhou, 730030, Gansu, China
| | - Zhilong Dong
- Department of Urology, Lanzhou University Second Hospital, No.82 Cui Ying Gate, Cheng Guan District, Lanzhou, 730030, Gansu, China
| | - Ganping Zhong
- Department of Urology, Lanzhou University Second Hospital, No.82 Cui Ying Gate, Cheng Guan District, Lanzhou, 730030, Gansu, China
| | - Hui Cheng
- Department of Urology, Lanzhou University Second Hospital, No.82 Cui Ying Gate, Cheng Guan District, Lanzhou, 730030, Gansu, China
| | - Pengyuan Lei
- Department of Urology, Xigu Branch of Lanzhou University Second Hospital, Lanzhou, Gansu, China
| | - Zhongming Li
- Department of Urology, Xigu Branch of Lanzhou University Second Hospital, Lanzhou, Gansu, China
| | - GongJin Wu
- Department of Urology, Lanzhou University Second Hospital, No.82 Cui Ying Gate, Cheng Guan District, Lanzhou, 730030, Gansu, China.
| | - Panfeng Shang
- Department of Urology, Lanzhou University Second Hospital, No.82 Cui Ying Gate, Cheng Guan District, Lanzhou, 730030, Gansu, China.
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Rooseno G, Hakim L, Djojodimedjo T. A systematic review and meta-analysis on the efficacy of preoperative renal artery embolization prior to radical nephrectomy for renal cell carcinoma: Is it necessary? Arch Ital Urol Androl 2023; 95:12018. [PMID: 38058293 DOI: 10.4081/aiua.2023.12018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Accepted: 11/02/2023] [Indexed: 12/08/2023] Open
Abstract
INTRODUCTION Radical nephrectomy for Renal Cell Carcinoma (RCC) is still the treatment of choice for all stages except for stage I and IV, which need patient selectivity. The purpose of Renal Artery Embolization (RAE) pre-operative before radical nephrectomy is to facilitate resection, reduce bleeding, and reduce the time to surgery, but the necessity of this procedure is still debatable. This study investigates the efficacy of pre-operative Renal Artery Embolization (PRAE) before radical nephrectomy for RCC patients. METHODS The systematic searches based on PRISMA guidelines were conducted in Pubmed, Scopus, Web of Science, Medrxiv, and ScienceDirect databases with pre-defined keywords. Both analyses, quantitative and qualitative, were performed to assess blood loss, transfusion rate, surgical time, Intensive Care Unit (ICU) stay, and hospital stay. RESULTS A total of 921 patients from 8 eligible studies were included. The blood loss was significantly lower in the PRAE group compared to the control group (p = < 0.00001; SMD -20 mL; 95%CI -0.29, -0.12). There is no statistically significant difference between RAE and without RAE in the transfusion rate nephrectomy (p = 0.53, OR 0.65; 95% CI 0.16, 2.57), mean operative time (p = 0.69; SMD 5.91; 95% CI -23.25, 35.07), mean length of hospital stay (p = 0.05; SMD 0.56; 95% CI 0.00, 1.12), and mean length of stay in the ICU (p = 0.45; SMD 11.61; 95% CI -18.35, 41.57) Conclusions: PRAE before radical nephrectomy significantly reduces blood loss in RCC patients but is similar in the surgical time, transfusion rate, and length of hospital stay and ICU stay.
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Affiliation(s)
- Gullyawan Rooseno
- Department of Urology, Faculty of Medicine, Universitas Airlangga; Dr. Soetomo General-Academic Hospital, Surabaya, East Java.
| | - Lukman Hakim
- Department of Urology, Faculty of Medicine, Universitas Airlangga; Dr. Soetomo General-Academic Hospital, Surabaya, East Java.
| | - Tarmono Djojodimedjo
- Department of Urology, Faculty of Medicine, Universitas Airlangga; Dr. Soetomo General-Academic Hospital, Surabaya, East Java.
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Yilmaz EC, Belue MJ, Turkbey B, Reinhold C, Choyke PL. A Brief Review of Artificial Intelligence in Genitourinary Oncological Imaging. Can Assoc Radiol J 2023; 74:534-547. [PMID: 36515576 DOI: 10.1177/08465371221135782] [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] [Indexed: 12/15/2022] Open
Abstract
Genitourinary (GU) system is among the most commonly involved malignancy sites in the human body. Imaging plays a crucial role not only in diagnosis of cancer but also in disease management and its prognosis. However, interpretation of conventional imaging methods such as CT or MR imaging (MRI) usually demonstrates variability across different readers and institutions. Artificial intelligence (AI) has emerged as a promising technology that could improve the patient care by providing helpful input to human readers through lesion detection algorithms and lesion classification systems. Moreover, the robustness of these models may be valuable in automating time-consuming tasks such as organ and lesion segmentations. Herein, we review the current state of imaging and existing challenges in GU malignancies, particularly for cancers of prostate, kidney and bladder; and briefly summarize the recent AI-based solutions to these challenges.
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Affiliation(s)
- Enis C Yilmaz
- Molecular Imaging Branch, National Cancer Institute, NIH, Bethesda, MD, USA
| | - Mason J Belue
- Molecular Imaging Branch, National Cancer Institute, NIH, Bethesda, MD, USA
| | - Baris Turkbey
- Molecular Imaging Branch, National Cancer Institute, NIH, Bethesda, MD, USA
| | - Caroline Reinhold
- McGill University Health Center, McGill University, Montreal, Canada
| | - Peter L Choyke
- Molecular Imaging Branch, National Cancer Institute, NIH, Bethesda, MD, USA
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El-Asmar JM, Ayoub CH, Kfoury P, Abou-Mrad A, El-Hajj A. Surgical Complications Requiring Reoperation in Open Versus Minimally Invasive Radical Nephrectomy: A Contemporary Analysis of the National Surgical Quality Improvement Program. World J Surg 2023; 47:856-862. [PMID: 36587175 DOI: 10.1007/s00268-022-06869-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/25/2022] [Indexed: 01/02/2023]
Abstract
BACKGROUND To explore reoperation rates for different radical nephrectomy (RN) approaches that are experiencing a shift from open radical nephrectomy (ORN) toward minimally invasive surgery (MIS), we aimed to compare reoperation rates along with their culprit etiologies between the different types of surgical approaches for RN. METHODS The national surgical quality improvement program dataset was used to select patients who underwent RN between the years 2012-2019. A 1:1 propensity score matched analysis was used. Reoperation rates and causes were then compared between open and MIS approach. RESULTS The propensity matched cohort included 15,294 patients. Reoperation rates due to large bowel injury (0.01 vs. 0.14%), vascular injury (0.07 vs. 0.22%), and other abdominal (0.5 vs. 0.77%) were more common in ORN as compared to MIS (MIS vs. ORN, respectively, p < 0.034). Reoperation due to hernia (0.14 vs. 0.03%) was more common in MIS as compared to ORN (p = 0.027). No difference was seen for small bowel injury and incision/wound debridement. General reoperation (1.61 vs. 2.22%) and mortality (0.57 vs. 1.47%) were also more common in ORN as compared to MIS (p < 0.008). CONCLUSION Reoperation due to large bowel injury, vascular injury, and other abdominal was more likely to occur in ORN. Whereas reoperation due to hernia was more likely to occur in MIS. Surgical approach was an independent risk factor for immediate and early reoperation rates in RN patients. These results could be used to counsel patients pre-operatively on possible surgical approaches and complications.
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Affiliation(s)
- Jose M El-Asmar
- Department of Surgery, Division of Urology, American University of Beirut Medical Center, Riad El Solh, PO BOX: 11-0236, Beirut, 1107 2020, Lebanon
| | - Christian Habib Ayoub
- Department of Surgery, Division of Urology, American University of Beirut Medical Center, Riad El Solh, PO BOX: 11-0236, Beirut, 1107 2020, Lebanon
| | - Peter Kfoury
- American University of Beirut Medical School, American University of Beirut, Beirut, Lebanon
| | - Anthony Abou-Mrad
- American University of Beirut Medical School, American University of Beirut, Beirut, Lebanon
| | - Albert El-Hajj
- Department of Surgery, Division of Urology, American University of Beirut Medical Center, Riad El Solh, PO BOX: 11-0236, Beirut, 1107 2020, Lebanon.
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Singh UP, Madhavan K, Yadav P, Soni R, Lal H, Sureka SK, Kapoor R, Srivastava A. A Computed Tomography Angiography (CTA): Based score (SGPGI score) to predict level of difficulty, operative, and postoperative outcomes for right-sided radical nephrectomy. Urologia 2021; 89:347-353. [PMID: 34313503 DOI: 10.1177/03915603211015541] [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
OBJECTIVE With the advent of laparoscopic approach for the large (T1b-T3a ± N1) right renal masses, higher rates of complications and conversion to open surgery are being reported. The role of preoperative angioembolization (PAE), which has increased cost and inherent morbidity but may help in select circumstances has also not been clearly defined in the literature. We therefore devised a scoring system (SGPGI score) based on pre-operative Computed Tomography Angiography (CTA) to predict the level of difficulty of radical nephrectomy and enhance its safety and efficacy which could also be used for the judicious use of PAE in selected cases. METHODS In a prospective observational study on 52 patients with right renal masses from January 2014 to July 2018, we calculated a score based on CTA parameters. The patients were stratified for type and duration of surgery, blood loss, postoperative stay, and Clavien-Dindo grade of postoperative complications. RESULTS Patients were classified into three groups based on our scoring system. Progressively groups with higher score had higher blood loss, operating time, complications and hospital stay, and were more likely to have undergone conversion to open surgery (Area under curve 0.8625 for a cut off score of 10). Intraclass Correlation Coefficient (ICC) was 0.678-1 for the different components of our score. CONCLUSION The pre-operative CTA based SGPGI score evaluates right renal masses and is able to predict intra-operative difficulties effectively, leading to enhancement of surgery safety and efficacy. It also helps judiciously use PAE.
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Affiliation(s)
- Uday P Singh
- Department of Urology and Renal Transplantation, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Kumar Madhavan
- Department of Urology and Renal Transplantation, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Priyank Yadav
- Department of Urology and Renal Transplantation, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Rahul Soni
- Department of Urology and Renal Transplantation, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Hira Lal
- Department of Radiodiagnosis, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Sanjoy K Sureka
- Department of Urology and Renal Transplantation, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Rakesh Kapoor
- Department of Urology and Renal Transplantation, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Aneesh Srivastava
- Department of Urology and Renal Transplantation, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
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Dobrońska K, Jureczko L, Kowalczyk R, Dobroński P, Trzebicki J. Open kidney cancer surgery and perioperative cardiac arrhythmias. Cent European J Urol 2020; 73:432-439. [PMID: 33552568 PMCID: PMC7848839 DOI: 10.5173/ceju.2020.1734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Revised: 12/04/2020] [Accepted: 10/06/2020] [Indexed: 11/22/2022] Open
Abstract
Introduction Although cardiac arrhythmias during anesthesia are often observed, the literature focuses mainly on cardio-thoracic surgery. We aimed to evaluate the incidence of arrhythmias appearing in the perioperative period in patients undergoing urological surgery and furthermore to define whether combining general with epidural anesthesia prevents them. Material and methods The study included 50 adults, without a prior cardiac or arrhythmia history, undergoing an open kidney cancer surgery, who were randomly allocated to receive either general or combined epidural/general anesthesia. A Holter monitor was applied the evening before the surgery, tracing continuously for a period of 24 hours (7PM–7PM). ClinicalTrials.gov NCT02988219 Results There was no statistical difference in the arrhythmia occurrence between the randomization groups. Among 65.21% the following arrhythmias were observed: 27 – bradycardia, 4 – sinus pause, 6 – ventricular extrasystoles (>1000/24 hours), 3 – supraventricular extrasystoles (>200/24 hours). The patients with arrhythmia were older and often with hypertension (p <0.01). A longer surgery duration predisposed to arrhythmia appearance (122.5 vs. 99 minutes), (p <0.01). The temperature measured at the beginning and at the end of the surgery was significantly lower among the participants with arrhythmia (p = 0.02, p = 0.01). The gender, body mass index (BMI), laboratory tests and the intake of intravenous fluids did not influence the occurrence of arrhythmia. Conclusions Perioperative cardiac arrhythmias (usually sinus arrhythmias) are common during an open kidney surgery and occur regardless of the anesthetic technique and usually do not require any treatment. Age, hypertension, long operation time or low body temperature predispose the patient to perioperative cardiac arrhythmias during surgery.
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Affiliation(s)
- Karolina Dobrońska
- First Department of Anesthesiology and Intensive Care, Medical University of Warsaw, Warsaw, Poland
| | - Lidia Jureczko
- First Department of Anesthesiology and Intensive Care, Medical University of Warsaw, Warsaw, Poland
| | - Rafał Kowalczyk
- First Department of Anesthesiology and Intensive Care, Medical University of Warsaw, Warsaw, Poland
| | - Piotr Dobroński
- Department of Urology, Medical University of Warsaw, Warsaw, Poland
| | - Janusz Trzebicki
- First Department of Anesthesiology and Intensive Care, Medical University of Warsaw, Warsaw, Poland
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Zhang S, Luo Y, Wang C, Xiong H, Fu SJ, Yang L. Open surgery versus retroperitoneal laparoscopic nephrectomy for renal tuberculosis: a retrospective study of 120 patients. PeerJ 2016; 4:e2708. [PMID: 27917313 PMCID: PMC5131615 DOI: 10.7717/peerj.2708] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2016] [Accepted: 10/20/2016] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Laparoscopic renal surgery has been widely used in the treatment of renal diseases. However, there is still little research about its application in addressing renal tuberculosis. The purpose of this study is to retrospectively investigate the surgical results of laparoscopic and open surgery for nonfunctional tuberculous kidneys. METHODS Between May 2011 and June 2016, 120 nephrectomies were performed in patients with a nonfunctional tuberculous kidney. Of these, 69 patients underwent retroperitoneal laparoscopic nephrectomy, and 51 patients underwent open nephrectomy. Data about the patients' characteristics and surgical outcomes were collected from their electronic medical records. Outcomes were compared between these two groups. RESULTS Our results showed that a number of renal tuberculosis patients presented no significant symptoms during their disease. Lower urinary tract symptoms (LUTS) were the most common at a rate of 73/120, followed by flank pain or accidently discovery (66/120), urine abnormality (30/120) and fever (27/120). Patients who underwent open surgery were similar to laparoscopic patients with regard to sex, BMI, location, previous tuberculous history, grade, anemia, adhesion, hypertension, diabetes and preoperative serum creatinine level, but were generally older than laparoscopic patients. There were no significant differences between open and laparoscopic surgery in estimated blood loss, transfusion, postoperative hospital days and perioperative complication rate. However, the median operation time of laparoscopic operation was much longer than open surgery (180 [150-225] vs 135 [120-165] minutes, P < 0.01). Seven of the 69 laparoscopic operations were converted to open surgery because of severe adhesions. CONCLUSION Laparoscopic nephrectomy is as an effective treatment as open surgery for a nonfunctional tuberculous kidney, although it requires more time during the surgical procedure. No significant differences in other surgical outcomes were observed.
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Affiliation(s)
- Su Zhang
- Department of Urology, Lanzhou University Second Hospital, Lan Zhou, China
| | - You Luo
- Department of Urology, Lanzhou University Second Hospital, Lan Zhou, China
| | - Cheng Wang
- Department of Urology, Lanzhou University Second Hospital, Lan Zhou, China
| | - Hu Xiong
- Department of Urology, Lanzhou University Second Hospital, Lan Zhou, China
| | - Sheng-Jun Fu
- Department of Urology, Lanzhou University Second Hospital, Lan Zhou, China
| | - Li Yang
- Department of Urology, Lanzhou University Second Hospital, Lan Zhou, China
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