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PubMed1992

Clinical study of patients with renal carcinoma surviving for more than 10 years after nephrectomy.

Of 207 patients with renal carcinoma we studied 50 who survived for more than 10 years after nephrectomy. These 50 patients were younger than the others at the time of operation and included more females. They had lower stage and lower grade tumours. Recurrence was detected in 18/50 patients and 6 died from cancer. Recurrence developed approximately 10 years after nephrectomy. Eleven patients with recurrences had metastases to a single organ and 9 received multidisciplinary treatment, mainly surgery and radiotherapy. The survival rate 10 years after nephrectomy was lower in patients with recurrences than in those without recurrent tumours and there was a significant decrease in the survival rate 17 years after nephrectomy. Although the patients had low grade and low stage tumours 10 years after nephrectomy, careful follow-up is recommended in such cases as it is possible that they may have dormant tumours.

Adult↗

PubMed1992

Bilateral asynchronous renal cell carcinoma. Computed tomography of the contralateral kidney 10-43 years after nephrectomy.

Computed tomography (CT) was carried out in 31 patients 10-43 years after surgery for renal cell carcinoma, 10 belonging to a consecutive series of patients operated upon at one urological department 10 years previously. Twenty-eight patients were symptomless, and 3 had flank pain, severe fatigue and hematuria, respectively. Cancers in the remaining kidney were found 13-21 years after nephrectomy in 4 of 31 patients (12.9%). The 3 patients with symptoms were among these 4. An adenoma was found in 1 patient 10 years after nephrectomy. The cancers were treated by renal resection in 2 patients, multiple tumors made nephrectomy necessary in 1 patient and 1 patient was not operated upon because of disseminated disease. The adenoma indicated future checkup by CT. Three of the 4 new cancers had a dismal outcome. The renal parenchyma was found to be essentially normal in all the other 26 patients, irrespective of the widely varying time interval between nephrectomy and CT. Asynchronous bilateral renal cell carcinoma has a poor outcome which presumably can be improved by early diagnosis and aggressive treatment. CT is the method of choice for early detection and follow-up of renal tumors. It should be carried out every other year after nephrectomy for renal cell carcinoma.

Adult↗

PubMedDate not supplied

[Combination surgery in radical nephrectomy].

In 18 of 487 patients (11 males, 7 females) operated for renal cancer, radical nephrectomy was made simultaneously with cholecystectomy (n = 14) and prosthetic repair of the abdominal aorta (n = 4). A transabdominal approach was used in all the cases. Duration of radical nephrectomies from the transabdominal approach varies from 95 to 180 min while simultaneous operations lasted from 130 to 228 min. Cholecystectomy increased duration of the operations by 25-55, aortic repair--by 60-90 min. Conduction of concomitant operations had no negative effect on the course of postoperative period or on the number of complications. 18 cases of simultaneous operations (radical nephrectomy and cholecystectomy or aortic repair) showed that there was neither increased number of complications nor duration of hospital stay. Cholecystectomy can be made from the same incision as radical nephrectomy whereas aortic repair demands the middle approach which is not convenient for performance of radical nephrectomy.

Adult↗

PubMed2005

Laparoscopic nephrectomy for emphysematous pyelonephritis.

Emphysematous pyelonephritis is a serious suppurative infection of the renal and extrarenal tissues. Controversies exist surrounding the appropriate management of this life-threatening condition with advocates for both medical management alone and percutaneous drainage combined with nephrectomy. The laparoscopic approach for nephrectomy is quickly becoming the standard of care for benign disease of the kidney and low-stage renal cancers. We report a case of a 60-year-old diabetic male undergoing successful laparoscopic nephrectomy for right emphysematous pyelonephritis, and our procedural technique. To our knowledge, this is the first report of laparoscopic nephrectomy in the setting of emphysematous pyelonephritis. Carefully selected patients with emphysematous pyelonephritis may benefit from the advantages of laparoscopic nephrectomy in centers with sufficient laparoscopic experience.

Diabetic Nephropathies↗

PubMed2005

Multiple renal arteries in laparoscopic donor nephrectomy.

BACKGROUND: Laparoscopic donor nephrectomy has gained popularity throughout the world recently. The more centers became experienced the more this technique began to be used, even in extreme cases. Kidneys with multiple renal arteries are one of the difficult cases for laparoscopic donor nephrectomy. PATIENTS AND METHOD: Thirty living laparoscopic donor nephrectomies have been performed between January 2001 and December 2002. Twenty-three of them had single and seven kidneys had multiple renal arteries. Single (SA) and multiple (MA) artery groups were statistically similar in terms of donor age, rate of received right kidneys and serum creatinine clearance of the donors. RESULTS: The mean duration of the donor surgery was 225 min and 240 min in SA and MA groups. In the SA and MA groups, the mean warm and cold ischemia times were statistically similar. Laparoscopic nephrectomy was converted to open procedure in five and one donors, in the SA and MA artery groups, respectively. Intraoperative bleeding (single artery: 4, multiple arteries: 1) was the most common cause for conversion. Postoperative urinary complications were seen in four and one patients, in the SA and MA groups, respectively. Lengths of hospital stay of the donors were similar in both groups. Serum creatinine levels of the patients on seventh, 30th, 90th days, and 1 year were found to be statistically similar in both groups. CONCLUSION: Laparoscopic donor nephrectomy was found to be a safe procedure in the donors with multiple renal arteries by the experienced surgical teams, as much as in donors with single arteries.

Adult↗

PubMed2006

[Nephrectomy in denmark 2002-2005].

INTRODUCTION: Implementation of principles of fast-track surgery as well as laparoscopy may decrease hospital stay after nephrectomy to about 2-4 days. The aim of this study was to analyse the incidence, use of laparoscopic vs. open nephrectomy, hospital stay, morbidity and mortality in Danish hospitals within the period 2002-2005. METHODS: Extraction of information from the National Patient Register (LPR) and discharge notes from Jan. 1 2002 to Dec. 31 2004. RESULTS: In the 3-year period, 1968 nephrectomies were performed in a total of 45 departments, decreasing to 29 departments in 2004. Five departments performed > 100 operations during the 3 years, 10 departments performed between 50-100 operations and 30 departments <50 operations during the 3 years. The average length of hospital stay (primary and readmission) was 9.1 days. The total mortality rate was 2.2%; lower (1.5%) in departments with high activity vs. departments with low activity (4.3%, p < 0.01). Laparoscopic surgery was performed in 11 departments with a hospital stay of 5.2 vs. 9.5 days and with fewer surgical and medical complications and mortality (0.4% vs. 2.5%), compared with open operation. CONCLUSION: The organisation and results after nephrectomy are not optimal on a nationwide basis. This precludes further optimisation of the early perioperative results, including use of the laparoscopic approach combined with the principles of fast-track surgery. It is suggested that nephrectomy in the future is performed in fewer departments to fulfil these needs.

Denmark↗

PubMed2006

[Laparoscopic partial nephrectomy: A series of 17 cases].

OBJECTIVE: The objective of this study was to evaluate the Feasibility, the morbidity and the carcinologic results of laparoscopic partial nephrectomy. MATERIAL AND METHODS: Between August 2001 and December 2005, 17 partial nephrectomies were performed by laparoscopy in patients with a mean age of 59.2 years. Postoperative complications, the conversion rate, operating time, arterial clamping time, length of hospital stay and oncological results were studied for each patient. RESULTS: The mean operating time was 190 min, the mean arterial clamping time was 30 min and the mean hospital stay was 6.3 days. There were 2 complications including one postoperative haematoma requiring surgical revision for drainage and repositioning of a stent for urine leak. Two conversions had to be performed early in our experience. A tumour recurrence 2 years after the initial operation was treated by total nephrectomy. CONCLUSION: Our results in terms of morbidity are similar to those reported for open surgery, but the recurrence rate appears to be slightly higher than that observed with open partial nephrectomy. Laparoscopic partial nephrectomy remains a difficult operation requiring a learning curve even for a department that regularly performs laparoscopic surgery.

Adult↗

PubMed2006

Apoptosis and proliferation of mesangial cells isolated from kidneys undergoing compensatory growth following contralateral nephrectomy: role of the renin-angiotensin system.

BACKGROUND: Contralateral nephrectomy stimulates compensatory growth of the remaining kidney. Intensive growth is frequently associated with increased apoptosis. The proliferation and apoptosis of cultured rat mesangial cells isolated from the remaining kidney following contralateral nephrectomy were evaluated. The involvement of the renin-angiotensin system was concomitantly assessed. MATERIAL/METHODS: Apoptosis was assessed by TUNEL assay and hematoxylin staining, proliferation by (3)H-thymidine incorporation, angiotensin-II (A-II) production by RIA, bradykinin synthesis by specific EIA, and AT-1/AT-2 receptor mRNA expression by RT-PCR.( 125)I-A-II labeling was applied for AT-1/AT-2 receptor density evaluation. RESULTS: Apoptosis of unstimulated control cultures progressively increased from a baseline of 2.02+/-0.55% to 8.3+/-1.19% in 30-min and 12.8+/-4.11% in 24-h cultures (p<0.0001 in each comparison), accompanied by augmented cell proliferation and both could be abolished by captopril treatment. Endogenous A-II synthesis was increased in postnephrectomy cultures. Exogenous A-II enhanced apoptosis of control, but not of postnephrectomy cells. Bradykinin synthesis was elevated in cultures treated with captopril, but not with losartan or PD123319. AT-1 mRNA was increased 24 h following nephrectomy. Total A-II receptor density was decreased 30 min and 24 h following nephrectomy, while blockade of AT-1/AT-2 receptors was ineffective. CONCLUSIONS: 1. Contralateral nephrectomy stimulates apoptosis and proliferation of mesangial cells in the remaining kidney via increased endogenous A-II. 2. The mechanism by which A-II triggers apoptosis and proliferation of mesangial cells is not related to the AT-1/AT-2 receptor pathway. 3. The effects of angiotensin-II can be abolished by ACE inhibition and are, at least in part, mediated via bradykinin activity.

Angiotensin I↗

PubMed1990

[Changes in the dimensions of the remnant kidney after nephrectomy of the pathologic contralateral kidney in adults].

Compensatory renal hypertrophy is a process that has been known since Gustav Simon performed the first nephrectomy procedure in man in 1869. The present study reviews the literature and analyzes the factors relating to this process and its morphologic features. It has been reported that the degree of renal hypertrophy depends, among other factors, on the amount of nephrons lost as well as adaptative capacity of the surviving kidney when the pathologic kidney is removed. The present study also reports the changes in size of the surviving kidney observed at 6, 30, and 90 days after removal of the pathologic kidney in 40 patients. The results show a significant increase 6 days following nephrectomy and a significant decrease at 30 days to mean values higher than those of the preoperative evaluation. Ninety days after nephrectomy, these values significantly increase again but do not reach the same levels as those observed 6 days after nephrectomy. These findings are ascribed to the hemodynamic changes resulting from nephrectomy. These manifest immediately after the procedure and remain unchanged for days and subsequently the structural changes of renal hypertrophy prevail.

Humans↗

PubMed1989

Renal handling of electrolytes and (Na + K)-ATPase activity after unilateral nephrectomy during long-term ethanol feeding.

The effect of long-term ethanol feeding on the activity of (Na + K)-ATPase in cortex and outer medulla and fractional excretion of electrolytes in remnant kidney of adult rats after unilateral nephrectomy were studied. Wistar adult rats were fed 20% (v/v) aqueous ethanol solution as sole drinking fluid for 8-10 weeks. Right kidney was removed under ether anaesthesia. The animals were subjected to an acute NaCl loading by means of a continuous infusion given 2, 7 and 14 days after nephrectomy. Renal handling of electrolytes was estimated from fractional excretion of sodium and potassium. After the infusion the animals were killed and (Na + K)-ATPase and Mg2+-ATPase activities were measured in the cortex and outer medulla of the remnant kidney. Two days after nephrectomy both groups showed a gradual increase of renal (Na + K)-ATPase activity reaching 60 percent at day 14. Mg2+-ATPase activity did not change with respect to basal values. Compared to basal values the fractional excretion of sodium after nephrectomy, dropped in both groups but more significantly in the ethanol-fed rats than in the control group. Fractional excretion of potassium did not change in the control group after nephrectomy while the ethanol-fed group displayed a significative decrease at days 7 and 14. According to our results the rise in renal (Na + K)-ATPase activity is consistent with the renal sodium retention found in ethanol-fed rats.

Adaptation, Physiological↗

PubMed1987

The effect of low-dose dopamine on renal function in uninephrectomized patients: special emphasis on kidney donors before and after nephrectomy.

In rats, uninephrectomy and subtotal renal ablation result in the development of hypertension and proteinuria, and, in a progressively downhill course of renal function, to end-stage renal disease. These events are attributed to glomerular hyperfiltration of remnant glomeruli. In man, however, long-term effects of unilateral nephrectomy appear to be less disastrous. The infusion of a low dose of dopamine (1.5-2.0 micrograms/kg/min) can be used to test the presence of a reserve filtration capacity i.e., the absence or existence of glomerular hyperfiltration. In order to investigate whether in man glomerular hyperfiltration occurs after unilateral nephrectomy, the effects of low-dose dopamine on glomerular filtration rate (clearance of 125I-iothalamate) and effective renal plasma flow (clearance of 131I-hippurate) of 18 uninephrectomized patients were investigated and compared with the effects of low-dose dopamine on those parameters of 32 healthy volunteers. Special interest was given to a subgroup of 10 kidney donors who were investigated before and after nephrectomy. Median values for the percentage of a dopamine-induced rise in the glomerular filtration rate were 4.5% in the uninephrectomized subjects and 10.0% in the control subjects (p less than 0.01). Median dopamine-induced increase in effective renal plasma flow as 22.5% and 35.0%, respectively (p less than 0.01). In the kidney donors the median percentage of a dopamine-induced change in the glomerular filtration rate was 12.4% before and 5.9% after nephrectomy (p less than 0.05%). It is concluded firstly, that renal reserve filtration capacity is decreased after unilateral nephrectomy.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed1985

Nephrectomy following trauma--impact on patient outcome.

Nephrectomy for trauma is done infrequently due to the success of renal sparing procedures. The purpose of this review was to quantitate the effect of nephrectomy on patient outcome. Over a 5-year period 55 of 783 patients had renal injuries confirmed at trauma laparotomy. Nephrectomy was performed in 14 (25%) of these patients. Thirteen patients had penetrating injuries (12 gunshot wounds, one stab wound) and one patient was the victim of blunt trauma. The average number of associated injuries was 3.6. Three patients exsanguinated intraoperatively. Renal failure (serum creatinine greater than 2.5 mg%) developed in four patients; three required hemodialysis. The average time of onset of renal dysfunction was 3 weeks, and in every case it was preceded by intra-abdominal sepsis. Two patients died, both from multiple organ failure, on postoperative day 25 and 26, respectively. In the seven patients free of renal failure, one patient developed sepsis and subsequently died. Of the eight surviving patients, all had adequate renal function as evidenced by an average blood urea nitrogen of 14 mg%, serum creatinine of 1.3 mg%, and a creatinine clearance of 77 ml/min. Renal failure following nephrectomy for trauma occurs late in the hospital course and is invariably preceded by sepsis. Nephrectomy is a marker of severe intra-abdominal injury, but in itself is not the major determinant of survival.

Abdominal Injuries↗

PubMed1981

Evaluation of triple drug chemotherapy with or without right nephrectomy in the treatment of bilateral murine Wilms' tumor.

The effect of nephrectomy with or without chemotherapy was evaluated in bilateral implanted Wilms' tumor. There was no significant effect of chemotherapy on survival, primary tumor growth or the incidence of metastases to the lungs demonstrated in this study. Regrowth of tumor at the site of unilateral nephrectomy was prevented by the use of chemotherapy when nephrectomy was performed on day 3. The weight of the left kidney at autopsy of animals treated with nephrectomy only was greater than that of animals who received no treatment following bilateral implantation, suggesting that nephrectomy indirectly may have stimulated tumor growth in the residual kidney. The results suggested that future experimental studies of bilateral Wilms' tumor should include surgery and/or irradiation of the remaining kidney.

Animals↗

PubMed1983

Experience in the management of hypertension with unilateral chronic pyelonephritis: results of nephrectomy in selected patients.

We report the experience of a regional centre serving a population of 3 millions in the management of patients with hypertension and unilateral scarred kidneys between 1972 and 1981. Thirty one patients were studied, fifteen have been subjected to nephrectomy and sixteen managed conservatively. The medically and surgically treated patients differed only in that the diseased kidney was smaller, 7.7 +/- 1.9 vs 9.9 +/- 1.7 cm, (p less than 0.01), and systolic blood pressure higher, 224 +/- 34 vs 198 +/- 30 mmHg, (p = 0.05), in the surgically treated group. Following nephrectomy blood pressure was normal without drugs in four patients, control was made easier in 10 patients and only one patient, who had bilateral disease, failed to benefit. In the non-surgical group drugs could be withdrawn in only one patient and control became easier in only five. Serum creatinine did not increase following nephrectomy, but had increased significantly at the time of the most recent follow up in the medically treated patients (89 +/- 20 to 102 +/- 32 mumol 1(-1), p less than 0.05). We conclude that nephrectomy is of value in the management of some patients with unilateral chronic pyelonephritis and need not result in loss of renal function. Renal vein renin studies may be helpful in selecting patients for surgery but examination of the effect of nephrectomy in patients without differences in renal vein renin is necessary to establish this.

Adolescent↗

PubMed1978

[The bilateral nephrectomy in terminal renal disease (author's transl)].

45 cases of nephrectomy are reported. Mortality was 8.9%. Thirty-one had a drug-resistant, severe hypertension, three had infected kidneys, and in eleven cases nephrectomy was performed prior to transplantation. Although blood pressure improved in all patients, of the first group 24% died within one year after nephrectomy, which shows unsatisfactory prognosis of malignant nephrosclerosis. Only early nephrectomy can lead to better results. Routine nephrectomy before transplantation should be avoided. Indications for this group are discussed.

Adult↗

PubMed1995

A new renal tourniquet for open and laparoscopic partial nephrectomy.

PURPOSE: We describe a novel double loop renal parenchymal tourniquet for obtaining hemostasis during open and laparoscopic partial nephrectomy. METHODS: One loop is positioned around the upper and 1 around the lower renal poles, thus securely entrapping the kidney. During partial nephrectomy the corresponding loop is double looped and cinched, thus achieving a tourniquet effect. The renal artery is not occluded. Intraoperative renal hypothermia is not required. RESULTS: The renal tourniquet was used clinically during 6 open and 1 laparoscopic partial nephrectomies. Furthermore, during laparoscopic nephrectomy (5 porcine and 1 clinical cases) the double loop apparatus allowed for improved maneuverability of the kidney. CONCLUSIONS: The novel renal tourniquet affords adequate renal parenchymal hemostasis during open and laparoscopic partial nephrectomy.

Animals↗

PubMed1995

Is ipsilateral adrenalectomy a necessary component of radical nephrectomy?

Due to the increased use of modern imaging systems during the last few years, kidney tumors are often diagnosed at an earlier and less advanced stage. This fact implies a reevaluation of the operative technique of radical nephrectomy that was recommended 30 years ago. The ipsilateral adrenal involvement during radical nephrectomy for renal cell carcinoma is assessed and the necessity of its extirpation is discussed. Between September 1987 and September 1993, we performed 299 radical nephrectomies for renal cell carcinoma and removed 285 ipsilateral adrenal glands. Eleven adrenal glands (3.8%) were involved with the kidney tumor and 274 (96.2%) were free of disease. In 7 of the adrenal gland involved cases (63.6%) the tumor invaded the gland by direct extension from the superior pole of the kidney. In the other 4 cases the ipsilateral adrenal gland was affected by a metastatic lesion. In all 11 adrenal gland involved cases the tumors were at an advanced stage (the lowest was stage pT3N1). Our results led us to recommend adrenalectomy during radical nephrectomy only when direct extension of the kidney tumor into the gland is suspected (upper pole or large tumors) or when the adrenal is the site of a single metastasis. Macroscopically normal adrenal glands at radical nephrectomy should not be routinely extirpated. Metastatic renal cell carcinoma (not by contiguity) in the ipsilateral adrenal gland should be regarded as a stage M+ (distant metastasis) tumor.

Adrenal Gland Neoplasms↗

PubMed1996

[Laparoscopic bilateral nephrectomy of native kidney in kidney transplantation carriers].

Severe vesicouretheral reflux sometimes causes terminal renal failure which then requires renal transplantation. In these patients it may be necessary to perform bilateral nephrectomy when associated to serious hypertension or urinary infections with a significant clinical impact. This paper presents the clinical picture of a patient with a corpse renal transplantation, due to terminal renal failure secondary to reflex nephropathy, in whom it was necessary to perform bilateral nephrectomy due to the uncommon urinary infections requiring hospitalization for treatment. The bilateral nephrectomy was done through transperitoneal laparoscopic approach, using seven points for trocars introduction. The procedure lasted 4 hours and the patients was discharged within 48 hours with no complications. Accumulate experience in the use of laparoscopy in urology has allowed this technique to be feasible. After designing the experimental model, our group has had the chance to accomplish laparoscopic nephrectomies in humans. We believe that this is the first case of bilateral nephrectomy conducted in our country using the laparoscopic approach.

Female↗