SEARCH · PubMed Health

Results for “Nephrectomy”

Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 1,099 records · Page 61Linked to original sources

PubMed2005

Laparoscopic nephrectomy for congenital benign renal diseases in children: comparison with adults.

AIM: To compare the results of laparoscopic nephrectomy for congenital benign renal diseases in children and adults. METHODS: From August 1996 to February 2003, laparoscopic nephrectomies were performed on 26 children and 60 adults. Of these patients, 33 patients (17 children, 16 adults) with comparable diseases were included in the analysis. RESULTS: Disease was on the right side in 16 patients and on the left in 17. Operative and convalescence parameters, including operative time, blood loss, transfusion rate, conversion rate to open surgery, resumption of oral intake, hospital stay, and complication rate, were evaluated in both groups. Median operative time in the paediatric group was 140 min compared to 147.5 in adults (p=0.626). The estimated blood loss was significantly different (median 25 and 75 cm(3) in children and adults, respectively; p<0.001). Other operative and convalescence parameters were not statistically different. However, whereas no child required a blood transfusion, three adults (18.8%) did. No major perioperative complications occurred in the paediatric group, but open surgical exploration was needed due to retroperitoneal bleeding in a single adult. CONCLUSION: Our findings indicate that laparoscopic nephrectomy for congenital benign disease in children is achieved safely and that the modality offers additional advantages in children as compared to adults.

Adult↗

PubMed2005

Laparoscopic nephrectomy: the new gold standard?

Laparoscopic nephrectomy has lesser blood loss, quicker recovery and return to work, shorter hospital stay, lesser post operative pain and analgesia requirement associated with it compared to open nephrectomy along with having oncological equivalence to open nephrectomy for T1, T2 renal tumours and for level 1 renal vein invasion by tumour thrombus. It has assumed the status of the New Gold Standard.

Humans↗

PubMed1980

Reconstructive surgery versus nephrectomy in renal artery stenosis: comparison of effects on total and divided renal function and on blood pressure.

Twenty-six hypertensive patients with unilateral renal artery disease and normal overall renal function were treated surgically: eleven underwent arterial reconstruction and 15 unilateral nephrectomy. One year after operation there was similar reduction in blood pressure in each group (delta mean BP 45:3 mm Hg (p < 0.001) and 36.8 mm Hg (p < 0.001) respectively. contrary to previous reports, however, a small but significant improvement in overall renal function was observed in patients who underwent reconstructive surgery (delta mean serum creatinine--13.3 mumol/1 (p < 0.01); this was associated with a significant rise in para-aminohippurate (PAH) clearance in the operated kidney, while PAH clearance fell on the contralateral side. Overall renal function deteriorated in the patients who underwent unilateral nephrectomy (delta mean serum creatinine +22.7 mumol/1 (p < 0.01)). The latter was due partly to diminished clearance in the remaining kidney and partly to the loss of the excised kidney. The findings emphasise the superiority of renal artery reconstruction over nephrectomy in patients with renovascular hypertension.

Adolescent↗

PubMed2005

Assessment of 100 live potential renal donors for laparoscopic nephrectomy with multi-detector row helical CT.

PURPOSE: To retrospectively review the authors' experience with multi-detector row helical computed tomography (CT) in assessing 100 consecutive live potential renal donors. MATERIALS AND METHODS: Hospital ethical committee approval was obtained; informed patient consent was not required. One hundred potential renal donors underwent multi-detector row CT assessment. Nonenhanced, arterial phase, and nephrographic phase examinations were performed. Delayed topograms were acquired to visualize the collecting system anatomy. A vascular radiologist prospectively interpreted the multi-detector row CT images. A second vascular radiologist, blinded to the initial results, retrospectively reviewed the images. Eighty candidates subsequently underwent donor nephrectomy, including 70 laparoscopic donor nephrectomies (LDNs) and 10 open donor nephrectomies (ODNs). Surgical findings served as the reference standard for 80 kidneys. The imaging findings in all 100 candidates (200 kidneys) were reviewed, although these findings were considered observational data only because there was no reference standard for 120 kidneys. RESULTS: Multi-detector row CT findings predicted uncomplicated LDN in 67 of 70 patients. Small upper-pole capsular arteries arising from the distal main renal artery in two patients were not described in the multi-detector row CT report: In one patient, the arising vessels resulted in conversion to ODN because of bleeding; in the other patient, arterial reconstruction was performed. In another patient, conversion to ODN was necessary because of ongoing bleeding from an avulsed large lumbar venous tributary to the left renal vein. Observational data revealed that multiple renal arteries--most of which were accessory renal arteries--were seen in 52 (26%) kidneys. Early branching of the main renal artery was seen in 24 (12%) kidneys, and main renal arterial abnormalities were identified in six (3%). Capsular arteries were detected in 10 (5%) kidneys. Major variations in the anatomy of the main renal veins--including multiple right renal veins, a retroaortic left renal vein, and a circumaortic left renal vein--were seen in 28 (14%) kidneys. Large (>5 mm in diameter) systemic tributaries to the left renal vein were seen in 25 (25%) kidneys. There was no significant interobserver disagreement between the vascular radiologists. CONCLUSION: Multi-detector row CT findings can predict successful LDN in live potential renal donors.

Adult↗

PubMed1976

Compensatory phosphaturia after unilateral nephrectomy in the rat.

Within 24 hr after unilateral nephrectomy, fractional excretion of phosphate (FEp) by the remaining kidney is markedly increased. This increase in FEp occurs in throparathyroidectomized rats receiving fixed replacement doses of parathyroid hormone and, therefore, cannot be due to secondary hyperparathyroidism occurring in response to unilateral nephrectomy. In the avsence of any hormone replacement, the increase in FEp is much reduced, but still present. The increase in FEp cannot be ascribed to depression of overall tubular sodium reabsorption because it could be demonstrated in the absence of an increase in FENa. Phosphaturia following unilateral nephrectomy in the rat appears to be part of the complex of events that occur after acute reduction of renal mass; the exact mechanisms of its genesis are uncertain.

Animals↗

PubMed1985

Na-K-ATPase in isolated rabbit tubules after unilateral nephrectomy and Na+ loading.

Na-K-ATPase activity was studied in tubule segments from the cortex and medulla of rabbit kidneys under normal conditions, after unilateral nephrectomy, and after chronic salt loading. After unilateral nephrectomy kidney weight increased by 37% and Na-K-ATPase activity rose significantly in all nephron segments by 36-200% (P less than 0.01). Oral salt loading for 2 wk with 0.5% NaCl caused an increase in GFR and in absolute sodium excretion as well as reabsorption; plasma aldosterone decreased by 44% (P less than 0.005). In the proximal segments (PCT, CPST, OMPST, and TDL) there were no marked changes in Na-K-ATPase activity, whereas along the whole length of the ascending limb of Henle's loop (iMTAL, MTAL, and CTAL) there was a significant rise in the enzymatic activity of 30-200% (P less than 0.02). In the distal segments (DCT, CCD, and OMCD) there was a marked decrease of 50-60% (P less than 0.005) in Na-K-ATPase activity after the salt loading. We conclude that unilateral nephrectomy caused a general increase in Na-K-ATPase activity along the whole length of the nephron, and salt loading caused a selective increase in enzyme activity along the ascending limb of Henle's loop and decrease in the distal segments.

Adenosine Triphosphatases↗

PubMed1999

Radical nephrectomy for renal cell carcinoma: Is adrenalectomy necessary?

OBJECTIVES: The role of simultaneous adrenalectomy in combination with radical nephrectomy in the treatment for renal cell carcinoma (RCC) remains controversial. With nephron-sparing surgery being commonly applied, the indication for adrenalectomy has to be critically assessed. PATIENTS AND METHODS: In a retrospective analysis the outcome of 589 patients, who underwent ipsilateral adrenalectomy along with radical nephrectomy in the treatment for RCC between 1985 and 1997 at our institution, was evaluated. The mean follow-up time was 34 months (range 1-95). RESULTS: Histologically an ipsilateral adrenal metastasis was found in 19/589 patients (3.2%). 16/19 patients had >/= T3, 3/19 had T1 tumours. The average size of the primary tumours with adrenal metastasis was 7.8 cm (range 2.3-13) in diameter with no preferential primary tumour site within the kidney (6/19 upper, 4/19 middle and 9/19 lower third). Only 4/19 patients had suspect adrenal findings in preoperative diagnostics (ultrasound, CT scan). 6/19 (31.5%) patients with adrenal metastasis are alive without evidence of disease at a mean of 41 months (range 11-95) after surgery for RCC. CONCLUSIONS: The probability of adrenal metastasis correlates with primary tumour stage, but not with its location within the kidney. The preoperative diagnostics are not reliable concerning small adrenal metastases. We thus still recommend simultaneous adrenalectomy in those cases where radical nephrectomy in patients with RCC is indicated.

Adrenal Gland Neoplasms↗

PubMed1998

The proliferative responsiveness of mesangial cells to postnephrectomy serum declines progressively with time elapsing after contralateral nephrectomy.

Postnephrectomy serum has been proved to enhance proliferation of mesangial cells in culture. Studies in offspring to uninephrectomized (UNx) mothers indicate that it remains active for a long period following UNx. On the other hand, postnephrectomy renal compensatory growth in vivo is known to be completed within a short period. In this study we assessed the proliferative responses of mesangial cells from single kidneys of rats which were cultured 48 h or 4 months following contralateral nephrectomy. The proliferative stimulus was provided by different postnephrectomy sera. Proliferation of both experimental cell populations was significantly greater than that of controls. Moreover, the proliferation rate of early postcontralateral nephrectomy mesangial cells was greater than those harvested 4 months after nephrectomy. We, therefore, propose that the early in vivo completion of single kidney compensatory hypertrophy, at least in part, is due to progressive blunting of renal cell responsiveness to the mitotic stimulus of the animal's serum.

Animals↗

PubMed2001

Incidental splenectomy during left radical nephrectomy: reasons and ways to avoid it.

INTRODUCTION: Left radical nephrectomy is the second most common cause of incidental splenectomy during transabdominal oncological surgery in the upper left quadrant of the abdomen. The potential sequelae of splenic ablation are often underestimated and generally no systematic planned efforts have been undertaken to avoid a splenic injury. MATERIAL AND METHODS: We evaluated the incidence of iatrogenic splenectomy in 333 cases of left radical nephrectomy for renal cancer performed at our institute between 1970 and 1999. Two slightly different surgical techniques were adopted and after 1995 particular attention was paid to the possible causes of intraoperative splenic injury and how to avoid it. In the first group of patients (1970-1994) an anterolateral xipho-umbilical-subcostal approach was used, and in the second group (1995-1999) a cruciate "Mercedes-like" incision was always adopted. RESULTS: The incidence of iatrogenic splenectomy in the first group of patients was 13.2%, and only 2.6% in the second group. The mortality rate in the first group of patients was 6%; no mortality has been recorded in the second group. Postoperative infections averaged 12.1% in the first group and 11.6% in the second, without any difference between the two groups. However, if we consider the incidence of postoperative infections in splenectomy cases, the incidence reaches 24.2% in the first group versus no cases in the second. CONCLUSIONS: Incidental splenectomy is a potentially severe complication of transabdominal left radical nephrectomy and is often considered a price that has to be paid, particularly in cases of large tumoral masses. A more detailed knowledge of splenic anatomy, a critical consideration of the intraoperative factors that may lead to splenectomy, and the adoption of a surgical tactic borrowed from the techniques of liver transplant significantly lower the incidence of iatrogenic splenectomy.

Adult↗

PubMed2004

Retroperitoneal laparoscopic radical nephrectomy: experience of 23 cases.

INTRODUCTION: Retroperitoneal laparoscopic radical nephrectomy has recently been performed in several institutions for renal cancer. We report our experience with this type of operation and discuss the anatomy of perirenal fascial structures. PATIENTS AND METHODS: From July 2000 to May 2002, we performed retroperitoneal laparoscopic radical nephrectomy in 23 patients. We began this operation with longitudinal cutting of two layers of the posterior renal fasciae, and removed specimens without any fascial structure. RESULTS: Mean operative time was 203 min (range 129-314 min) with an average estimated blood loss of 113 ml (range 0-837 ml). There was 1 patient who required open conversion due to uncontrollable hemorrhage, but no complication was observed. CONCLUSIONS: Retroperitoneal laparoscopic radical nephrectomy is a safe and reliable method when the anatomy of the perirenal fasciae is clearly understood. Long-term follow-up of patients undergoing this procedure is warranted to its effect on the prognosis of renal cancer.

Adult↗

PubMed2006

Comparison of transperitoneal versus retroperitoneal approach in laparoscopic radical nephrectomy for renal cell carcinoma: a single-center experience of 63 cases.

BACKGROUND: We report our experience with the retroperitoneal (RP) and transperitoneal (TP) approaches for laparoscopic nephrectomy for clinically localized renal cell carcinoma. METHODS: Sixty-three patients with renal cell carcinoma were treated with laparoscopic nephrectomy, 34 by TP and 29 by RP approach between June 1999 and June 2003. Average age, ASA score, tumor stage and tumor size were similar in both groups. Early complications within 30 days and surgical time were retrospectively reviewed. RESULTS: Surgical time was with a mean of 183 and 190 minutes equal for the TP and RP approach. Intraoperative complications occurred in 4 patients and were vascular, requiring blood transfusion in 2 patients each per group. Postoperative complications were thromboembolism in 1 patient and subcutaneous seroma in 1 patient, both in the TP group. CONCLUSIONS: Although the sample size is small, it appears that the tumor control and surgical time in laparoscopic nephrectomy are not significantly influenced by the approach.

Carcinoma, Renal Cell↗

PubMed1983

Early changes of guanylate cyclase and cGMP phosphodiesterase activities in glomeruli and tubules isolated from the remaining kidney after unilateral nephrectomy in the rabbit.

Guanylate cyclase (GCase) and cyclic guanosine 3'5'-monophosphate-phosphodiesterase (cGMP-PDE) activities were measured in the medulla, glomeruli and cortical tubules isolated from the remaining kidney 5-120 min after unilateral nephrectomy. The results showed that cGMP-PDE-specific activities were unchanged in all the fractions isolated from the contralateral kidney when compared with the nephrectomized control kidney. The GCase-specific activity in the cortical and medullary tubules isolated from the remaining kidney reached a maximum by 10 min after unilateral nephrectomy and then returned to control values. On the other hand the glomerular GCase activity decreased for 10 min after unilateral nephrectomy, then rebound activity reached a maximum by 30 min and after 120 min had returned to the control value. The possible physiological signification of such variations is discussed.

3',5'-Cyclic-GMP Phosphodiesterases↗

PubMed1978

Increase in plasma extracellular fluid volume ratio caused by bilateral nephrectomy in patients on maintenance hemodialysis.

Changes, observed in rats after bilateral nephrectomy, in blood pressure and in the relation betwen plasma volume-extracellular fluid volume or plasma volume-interstitial fluid volume, are consistent with the postulation that the kidney secretes a substance that regulates, to some degree, the compliance of the interstitial space. In order to evaluate the possibility that this also occurs in humans, we have carried out a retrospective analysis of measurements of extracellular fluid volume, plasma volume, and blood volume made prior to and after bilateral nephrectomy in a group of 9 patients. It was observed that significant increases had occurred in both the plasma-extracellular fluid volume ratio (0.22 before, 0.26 after) and in the blood-extracellular fluid volume ratio (0.27 before, 0.32 after). These data are consistent with a reduction in compliance of the interstitial compartment caused by bilateral nephrectomy in man, even though other explanations cannot be excluded.

Adult↗

PubMed1988

Bilateral nephrectomy and dialysis as an option for patients with bilateral renal cancer.

Six patients who underwent bilateral nephrectomy for renal carcinoma were placed on maintenance dialysis; of these, 1 patient had a renal transplant. A 5-year 44% survival of these patients was observed. We feel that radical nephrectomy followed by chronic dialysis is a reasonable alternative and offers a fair prognosis to patients with bilateral renal cancer in which partial nephrectomy is not possible.

Adult↗

PubMed1990

Immediate induction of c-fos and c-myc transcripts following unilateral nephrectomy.

Unilateral nephrectomy in the rat results in contralateral compensatory renal growth. The immediate molecular events which occur in the remaining renal unit were studied by examining RNA isolated from these kidneys. Northern blot analysis was used to analyze the expression of the growth-related (c-fos and c-myc) genes during the 1-hour period following unilateral nephrectomy. Both c-fos and c-myc band transcripts were detected within 15 min after nephrectomy. The immediate, transient induction of these genes in the remaining renal unit mimics that seen during proliferative stimulation of cultured cells and may play a role in modulating the eventual compensatory growth response.

Animals↗

PubMed1991

Glomerular injury in analbuminemic rats after subtotal nephrectomy.

Progressive proteinuria has been suggested not just to reflect but also to contribute to the development of focal glomerular sclerosis. Development of proteinuria and glomerular lesions was examined up to 18 weeks after 3/4 nephrectomy in Sprague-Dawley (SDR) rats and an analbuminemic SDR variant (NAR). Nephrectomy led to a significantly lesser degree of proteinuria in NAR (42 +/- 14 SD mg/day) than in SDR (140 +/- 54 mg/day), consistent with the fact that 50-60% of urinary protein in SDR after nephrectomy is serum albumin. Nevertheless at 18 weeks NAR showed a significantly higher frequency of moderate and severe glomerular lesions than SDR. We conclude that, in this model, proteinuria itself is not a major cause of progressive glomerular injury.

Animals↗

PubMed1993

Glomerular growth in the remnant kidney after a contralateral nephrectomy.

A unilateral nephrectomy enhances growth or weight gain in the remaining kidney, although it is not known whether the mechanism involves the division of glomerular cells. We have isolated glomeruli from the remnant kidney at different time intervals after a nephrectomy and measured the percentage of cells in the G1, G2 + M and S phases by flow cytometry. All the steady-state glomerular cells remained in G1 phase, while a significant percentage had progressed into the S phase by 4 h after the uninephrectomy. The rise in the number of cells in the S phase gradually decreased to control values by 48 h, during which time the number of cells in both G1 and G2 + M phases increased concomitantly. Neither DNA nor RNA content per glomeruli was altered by 4 and 24 h after uninephrectomy. The data suggest an early division of the glomerular cells in the remnant kidney after a contralateral nephrectomy.

Animals↗

PubMed1984

Effect of unilateral nephrectomy on tumor growth of the murine renal cell adenocarcinoma and neuroblastoma.

Compensatory renal growth has been observed following contralateral nephrectomy in man and in certain animals. In a recent study of murine Wilms' tumor, tumor growth was observed to be affected by contralateral nephrectomy; therefore, a murine renal cell adenocarcinoma and neuroblastoma were evaluated. Comparison of tumors in sham-nephrectomized animals to tumors in mice who had undergone unilateral nephrectomy showed no significant increase in tumor weights. However, the contralateral kidney in the uninephrectomized animals had increased in weight as compared to that in tumor-bearing intact mice and the kidneys removed at uninephrectomy. This study demonstrates that factors influencing compensatory renal growth do not affect all renal tumors or other solid tumors.

Animals↗