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PubMed2004

[Comparative analysis of conservative surgery versus radical nephrectomy for renal cancer].

OBJECTIVES: To compare the results of conservative surgery (CS) and radical nephrectomy (RN) for the treatment of renal cancer. MATERIAL AND METHOD: Between 1988 and 1999, more than 900 patients were operated for renal cancer in our department. We compared results of CS (partial nephrectomy and/or lumpectomy) to those of RN on 2 groups of matched patients with a similar sample size (n=62) in terms of morbidity, course of renal function, oncological efficacy and survival. RESULTS: The mean follow-up was more than 5 years for the two groups. This series comprised a predominance of localized (pT1 and pT2) low-grade (1 and 2) tumours: 80%. In our experience, CS was responsible for greater morbidity than RN, essentially because of indications of necessity compared to elective indications. Although the local recurrence rate was significantly higher after CS, analysis of overall and specific survival did not reveal any significant difference between the two groups. CONCLUSIONS: Conservative surgery appears to be a reasonable alternative to radical nephrectomy for the treatment of renal cancer in some indications and allows nephron sparing. This option appears to be all the more justified in view of the increasingly frequent discovery of small tumours in increasingly young patients. The development of minimally invasive techniques, particularly laparoscopy, is another aspect of this "minimal" trauma approach, but must be shown to ensure an equivalent oncological efficacy.

Adenocarcinoma↗

PubMed2005

[Port site metastasis of primary adenocarcinoma of the renal pelvis after a laparoscopic nephrectomy: a case report].

We report a case of port site metastasis of primary adenocarcinoma of the renal pelvis after a laparoscopic nephrectomy. A 76-year-old woman was admitted to our hospital with a complaint of anorexia, general malaise and left abdominal distension. Computed tomography revealed severe hydronephrosis in the left kidney. Laboratory examination revealed a high serum level of CA19-9 (155 U/ml). However, antegrade and retrograde pyelography revealed no filling defects and urine cytopathology for renal pelvis showed no malignancy. Thus, on the suspicion of a ureteropelvic junction stenosis, a laparoscopic nephrectomy was performed. There were some papillary tumors in the renal pelvis and a histopathological examination of the tumor revealed a papillary adenocarcinoma. Twelve months after nephrectomy, left iliopsoas muscle metastasis was found. Thus irradiation therapy with a total of 30 Gy was performed. However, 3 months later, the patient developed metastasis at the trocar site and the serum level of CA19-9 elevated to 6,720 U/ml. She died of multiple metastases from adenocarcinoma of the renal pelvis 4 months after port site metastasis.

Abdominal Muscles↗

PubMed2005

[Prospective study of iliac extraction of the kidney after laparoscopic nephrectomy].

INTRODUCTION: Various routes are used to extract the operative specimen during laparoscopic nephrectomy. The main points are compliance with rules of cancer surgery, when applicable, and minimum wall destruction. The objective of this study was to prospectively evaluate the low iliac approach. MATERIAL AND METHOD: Prospective follow-up of 23 laparoscopic nephrectomies (17 tumours and 6 living donor kidney harvestings) in which the kidney was extracted via a low iliac incision measuring 5 to 7 cm. RESULTS: The mean operating time was 188 +/- 50 min with a mean blood loss of 112 +/- 126 ml. The mean duration of the incision was 10 minutes. In the case of a tumour the mean weight of the operative specimen was 571 +/- 127 g in and the mean diameter of the mass was 5.7 +/- 1.9 cm. All grafted kidneys functioned normally. No surgical conversion was necessary. The mean follow-up was 9.6 +/- 1.2 months. No late postoperative complications were observed. CONCLUSION: Radical nephrectomy or living donor kidney harvesting can be performed via laparoscopy with extraction of the operative specimen via a low iliac incision. This incision ensures extraction of very large specimens while preserving the aesthetic and functional advantages of laparoscopy with no increased cancer risk. They are simple to perform and easily reproducible via a transperitoneal or retroperitoneal approach. Absence of muscle section maintains the integrity of the abdominal wall. No postoperative incisional hernia has been observed.

Female↗

PubMed2005

Hand-assisted laparoscopic versus open nephrectomies in living donors.

UNLABELLED: Shortages of cadaveric kidneys for transplant into rising numbers of patients with end-stage renal failure have increased the demand for kidneys from live donors. The morbidity associated with traditional open donor nephrectomies (ODN) may discourage many candidates. The newer laparoscopic technique has been promoted as having less morbidity. OBJECTIVES: To evaluate outcomes of hand-assisted laparoscopic nephrectomies (HALN) and prospectively compare HALN and ODN. METHODS: After retrospectively reviewing donor and recipient outcomes in 33 HALN (December through August, 2000), we prospectively compared another 47 with 30 ODN performed from September 2000 through April 2001. RESULTS: All 80 HALN were successful, with no requirement to convert to an open procedure. Four donors experienced surgery-related complications: wound infection, retroperitoneal hematoma, prolonged ileus and early small-bowel obstruction, respectively. Two recipients had ureteral complications (1 stricture, 1 leak); 5 experienced delayed graft function, 2 requiring dialysis; and 2 kidneys were lost from infarction. The prospective comparison showed the operative time for HALN (mean 184 min, standard deviation [SD] 39 min) was significantly longer (143 [SD 27] min, p < 0.01), but resulted in less blood loss (p < 0.05). Lengths of time to warm ischemia/early graft function, resumption of oral intake/first bowel movement, and hospital discharge were similar. The abdominal-wall laxity and loss of cutaneous sensation from the flank incision experienced by many ODN patients after was uncommon in the HALN group. Three months after nephrectomy, donor complaints of incisional pain were less common after HALN (p < 0.01). CONCLUSIONS: HALN had good outcomes for donors and recipients, with quicker, more complete recoveries 3 months afterward.

Adult↗

PubMed1991

Renotropic functions of hepatocyte growth factor in renal regeneration after unilateral nephrectomy.

Hepatocyte growth factor (HGF), a most potent growth factor for mature hepatocytes may act as a trigger for liver regeneration. We reported that HGF strongly stimulates DNA synthesis of rabbit renal tubular cells in secondary culture (Igawa, T., Kanda, S., Kanetake, H., Saitoh, Y., Ichihara, A., Tomita, Y., and Nakamura, T. (1991) Biochem. Biophys. Res. Commun. 174, 831-838). To investigate whether or not HGF is involved in renal regeneration, we examined changes in HGF mRNA, HGF activity, and HGF receptor in the rat kidney following unilateral nephrectomy or treatment with carbon tetrachloride (CCl4). In the intact kidney, the HGF mRNA increased markedly reaching a maximum 6 h after unilateral nephrectomy, followed by an increase of HGF activity at 12 h after the surgery. The marked increase in HGF mRNA and HGF activity was also found in the kidney of rats treated with CCl4. Results of in situ hybridization suggested that cells producing HGF in the kidney are endothelial cells. The number of HGF receptors on renal plasma membranes decreased to 30% of the normal value 12 h after unilateral nephrectomy, with no change in the Kd value. The HGF receptor was greatly diminished 24 h after the operation, and recovery to 60% of the normal level was evident 1 week after the operation. Because the decrease in HGF binding may result from internalization of the HGF receptor, the HGF may bind to its receptor in vivo and act as a mitogen for renal epithelial cells. HGF may function as a renotropic factor during renal regeneration after kidney injury.

Animals↗

PubMedDate not supplied

The development of a laparoscopic donor nephrectomy program in a de novo renal transplant program: Evolution of technique and results in over 200 cases.

BACKGROUND AND OBJECTIVES: In 1999, our institution began a kidney transplant program with collaboration between the departments of General Surgery/Transplantation and Urology. From the onset, donor nephrectomies were performed laparoscopically and are currently the domain of Urology, which had no prior laparoscopic experience before this undertaking. We reviewed our experience. METHODS: A database of our experience was kept prospectively from June 1999 to November 2004. Records of both donors and recipients were reviewed. Special attention was directed toward our changes in technique and their relationship to outcomes, with emphasis on graft extraction and overall complication rates. RESULTS: We reviewed the records of 205 consecutive procedures. We report excellent donor outcomes, including mean operative time (112 minutes), estimated blood loss (120 mL), and length of stay (2.3 days). Complication (14.1%) and open conversion (1.5%) rates were low. For the recipients, early (98.0%) and 1-year (94.7%) graft survival, and ureteral ischemia (2.4%) rates were also appropriate with contemporary experience. CONCLUSIONS: We report our results on laparoscopic donor nephrectomy in a de novo renal transplant program. Because of this experience, we have ventured into other horizons of urologic laparoscopy and currently produce enough volume to support a laparoscopic fellowship. We feel that a productive donor nephrectomy program can enhance urologic laparoscopic programs and should be taken advantage of when available.

Adult↗

PubMedDate not supplied

[Local recurrence of renal cell carcinoma after radical nephrectomy].

Radical nephrectomy was made in 483 patients with renal cell carcinoma (RCC) without metastases admitted to National Urology Center in 1989-2004. Isolated local recurrence was observed in 10 (2.07%) patients who were divided into two groups. The recurrent tumor was removed in 6 patients of group 1, four patients of group 2 received conservative treatment. Statistic processing was made with Kolmogorov-Smirnov test and unmatched t-test. Survival was estimated according to Kaplan-Meyer, significance of the differences--by log rank test. Three patients of group 1 died of progression of basic disease. Only 1 patient from group 2 was alive 22 months after detection of the recurrence. Mean survival in group 1 was 27.5 +/- 14.9 months, in group 2--10 +/- 8.5 months (p = 0.045). A mean size of the recurrent tumor in survivors was 5.4 +/- 2.1 cm, while in dead patients--10.05 +/- 2.76 cm (p = 0.02). Radicalism of the recurrent tumor removal influenced survival of the patients (p = 0.019). In survivors local recurrence developed 35.7 +/- 28.1 months after radical nephrectomy; in the deceased the recurrence arose 23.3 +/- 25.5 months after nephrectomy (p = 0.46). Thus, early detection of isolated local recurrence of a relatively small size allows complete recovery in some surgically treated patients.

Carcinoma, Renal Cell↗

PubMed1991

[Effect of badoushuang on progressive glomerular sclerosis in rats with 7/8 nephrectomy].

Effect of Badoushuang (Semen crotonis pulveratum) was studied in the 7/8 nephrectomied rats, which we could establish as progressive glomerulosclerosis model in rats (Jap J Nephrol 32: 127, 1990). Badoushuang was administered into rats orally 60 mg/kg/day every day after 7/8 nephrectomy. As controls 7/8 nephrectomied rats were used. No adverse effect of Badoushuang were noted during 8 weeks of observation periods. Administration of Badoushuang, in rats with a remnant kidney, decreases urinary protein and lowers blood pressure, keeps creatinine clearance and lowers serum creatinine level and BUN. Morphologically glomerular hypertrophy, crescent formation and sclerosis were less in experimental treated rats. These results suggest Badoushuang ameliorates the progressive kidney disease of rats with subtotal renal ablation. Further study is necessary to clarify the effect of Basoushuang on progressive glomerular sclerosis.

Animals↗

PubMed1991

Effects of adrenalectomy and nephrectomy on adrenal regeneration hypertension in the rat.

The involvement of the regenerating adrenal gland and kidney, and the contribution of deoxycorticosterone (DOC) and prostaglandin E2 (PGE2), in the development of adrenal regeneration hypertension (ARH) was evaluated in young female Sprague-Dawley rats. Based on tail-cuff plethysmographic measurement, animals subjected to nephrectomy and adrenalectomy on the right side and adrenal enucleation (removal of the adrenal cortex) on the left side developed significant (P less than 0.05, n = 12) hypertension within 6 weeks following operation. Subsequent left nephrectomy in these ARH rats produced a further elevation, whereas a secondary adrenalectomy resulted in an acute and discernible reduction in blood pressure within 24-36 hours. It is interesting to note that the progressive increase in blood pressure following left nephrectomy was significantly reversed by PGE2 (10 or 20 micrograms/kg, i.p.). At the same time, the reduction in blood pressure after secondary adrenalectomy was significantly retarded by deoxycorticosterone trimethylacetate (2 mg/kg, i.p.). These data demonstrated that both the kidney and the regenerating adrenal cortex are involved in the pathogenesis of ARH. Furthermore, it is probable that the secretion of DOC by the regenerating adrenal cortex is responsible for the elevation in blood pressure, in a process that is balanced by PGE2, possibly secreted by the kidney.

Adrenal Glands↗

PubMed1990

[Suppression of the immediate pressive response to unilateral nephrectomy by atrial natriuretic peptide in the rat].

Unilateral nephrectomy (UNX) is associated with an immediate and transient increase in arterial pressure and in prompt natriuresis from the remaining kidney. The hypothesis that atrial natriuretic peptide (ANP) is involved in the acute adaptation to unilateral nephrectomy was tested in euvolemic anesthetized Sprague-Dawley rats. In a first series of experiments, an increase in circulating ir-ANP levels (from 23.5 +/- 3.6 to 66.3 +/- 12.8 fmol/ml; p less than 0.01) was found within 2 minutes following renal exclusion. In a second set of experiments, the ANP response was inhibited by performing a right atrial appendectomy, in order to eliminate the major source of ANP, or by intravenous administration of monoclonal antibodies directed against ANP. When UNX was performed in the control groups (sham atrial appendectomy and administration of non specific monoclonal antibodies), mean arterial pressure rose immediately (maximal about 12% within 4 minutes) and transiently (return to pre-UNX values within 20 minutes) after UNX. At the same time, central venous pressure, monitored in the right atrium, tended to decrease slightly. In rats pretreated by right atrial appendectomy or by monoclonal antibodies directed against ANP, arterial pressure increased to the same extent as observed in control groups; this increase however was significantly more prolonged. In control groups, urinary cGMP excretion, the biological marker of ANP, increased twofold in parallel with the natriuretic response. These two responses were blunted in right atrial appendectomized rats and in rats receiving antibodies against-ANP. These results suggest that atrial natriuretic peptide plays a major role in the immediate functional adaptation to unilateral nephrectomy by blunting the increase in blood pressure.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗

PubMedDate not supplied

[Changes in creatinine clearance and fractional sodium excretion by the remaining kidney after nephrectomy of the contralateral diseased kidney in the adult].

Unilateral nephrectomy causes immediate changes in renal plasma flow, glomerular filtration, and fractional sodium excretion of the remnant kidney. The present study reviews some aspects of reports published elsewhere relative to renal function adaptation after unilateral nephrectomy and presents the observed changes in creatinine clearance, fractional sodium excretion at 6, 30 and 90 days following removal of kidneys with chronic urologic disease and poor function, in a total of 20 patients. The results obtained show a gradual increase of creatinine clearance in most of the patients, although this increase was not statistically significant. On the other hand, fractional sodium excretion rose significantly at 30 and 90 days after nephrectomy. These findings can be interpreted in the following way: among the regulatory mechanisms, at 6 days postnephrectomy there is a predominance of the effects of increased CINa load to the distal tubule with activation of the renin-angiotensin system, as well as those produced by sympathetic efferents characteristic of the immediate postoperative period. However, at 30 and 90 days, the effects that seem to predominate are due to the expansion of the volume of extracellular fluid. Data obtained at 90 days indicate that balance seems to become stable.

Adaptation, Physiological↗

PubMed1990

Nephrectomy. A review of the surgical approaches.

Preoperative investigations determine the site, size, extent, and nature of the renal disease, which dictates the type of nephrectomy to be performed. The two basic surgical approaches to the kidney are lateral and anterior, each with its own advantages and disadvantages. Adequate exposure, careful dissection, and individual ligation and division of the renal vessels minimizes the complications with nephrectomy. A chest x-ray on the postanesthesia recovery room will rule out a pneumothorax following nephrectomy.

Humans↗

PubMed1990

[Segmental polar nephrectomy].

On the basis of anatomical studies of renal vessels, segmental polar nephrectomy has been designed. The key point is to identify blood-loss area of the segmental pole by interruption of the upper or the lower segmental polar artery before partial nephrectomy. The merits of the procedure are non-compression of the renal pedicle vessels, appropriate extent of the segmental polar nephrectomy and less hemorrhage.

Adult↗

PubMed1989

Catheterisation for nephrectomy?

A retrospective review of 64 nephrectomies performed in 1985 and 1986 revealed an incidence of postoperative catheterisation of 48%, compared with 20% in an age and sex matched group of patients undergoing cholecystectomy (P less than 0.01). In the 27 male patients over 40 years of age undergoing nephrectomy, there was a 75% incidence of postoperative catheterisation. A figure of 47% was found for the comparable female group. We recommend that routine peroperative catheterisation should be performed in patients over 40 years of age undergoing a nephrectomy.

Adult↗

PubMed1989

[A partial nephrectomy in renal cell carcinoma].

Two patients with a renal cell carcinoma under went a partial nephrectomy. In both these cases the renal cell carcinoma had been detected incidentally and the lesion was a localized small tumor. Therefore, a partial nephrectomy was performed similarly, the tumor size was 1.8 x 1.7 cm in both cases, but the histologic grading was grade 1 in one case and grade 2 in the other though the stage was pT2VoNoMo, stage 1 in both. We thus consider it recommendable that a partial nephrectomy be performed not only in cases of a solitary or bilateral renal cell carcinoma but also in selected cases of a renal cell carcinoma with normal contralateral kidney.

Carcinoma, Renal Cell↗

PubMed1989

[Kidney function in the course of compensatory hypertrophy following unilateral nephrectomy in the Wistar rat].

Unilateral nephrectomy was performed in 109 male Wistar rats, 35 animals served as controls. Determinations of glomerular filtration rate (GFR) using slope clearance of 99mTc-DTPA and of tubular function using an orally water-loading test were made. The tests were performed 2 and 5 days as well as 2, 4, 5 and 6 weeks after nephrectomy. In all examinations the GFR was more than 50% of the level of two-kidney control animals. Fractional maximum diuresis was increased in the first 2 examinations after nephrectomy from 8.9 +/- 2.1 to 15.4 +/- 4.2% of the GFR and fractional clearance of osmotically free water from 6.8 +/- 1.9 to 10.9 +/- 3.5%. In the fourth and sixth week the proximal tubular reabsorption was increased and the glomerulo-tubular balance had been recovered. However, the minimal urine osmolarity was increased to 107.8 +/- 17.7 mmol/l and the osmotic load of the nephrons remained elevated. Possible clinical implications of the results are discussed.

Animals↗

PubMed1989

Sex vulnerability in the subtotal nephrectomy model of glomerulosclerosis in the rat.

Unilateral nephrectomy and contralateral ligation of two thirds of the renal arterial circulation were performed on male (N x M, n = 6) and female (N x F, n = 7) Sprague-Dawley rats. Sham nephrectomies were performed in 16 male and female control rats (SN x M, n = 8; SN x F, n = 8). Creatinine clearance corrected for body weight and systolic arterial blood pressure were equal in both nephrectomized groups after 1, 3, and 5 weeks. The appearance of proteinuria was delayed in N x F and was still significantly less than N x M after 5 weeks (79 +/- 22 vs 30 +/- 12 mg per 24 hours, p less than 0.05). Glomerular visceral epithelial cell protein reabsorption droplets and vacuolization were equal in N x M and N x F. N x F exhibited one fifteenth of the glomerulosclerosis seen in N x M (p less than 0.01). In addition, there was one fourth of the mesangial expansion, but this trend did not reach statistical significance (p greater than 0.05). Mean glomerular volume was similar in male and female sham-operated (p greater than 0.05) and nephrectomized rats (p greater than 0.05), and nephrectomy resulted in hypertrophy in both groups (p less than 0.01). Glomerular procollagen alpha 1(IV) mRNA levels were higher in N x M than in all other groups (p less than 0.05) and correlated with mesangial expansion and glomerular sclerosis (p less than 0.01) but not with systemic hypertension, proteinuria, or epithelial cell changes.(ABSTRACT TRUNCATED AT 250 WORDS)

Aging↗

PubMed1985

[Partial nephrectomy in nephroblastoma].

The authors analyse their 18 partial nephrectomies performed on 12 children with either a bilateral or a Wilms' tumor of a single remaining kidney: 13 affected kidneys were otherwise normal, the 5 others were sites of a diffuse nephroblastomatosis. The short term results are good (one technical failure only). The long term results were excellent for Wilms' tumors on otherwise healthy kidneys (no recurrence), as opposed to kidneys with diffuse nephroblastomatosis, where invariable tumor recurrence was observed. Because of the low risk of tumor development in the controlateral healthy kidney, and the established value of classical total nephrectomy, the authors, however, consider partial nephrectomy only in highly selected cases of unilateral nephroblastoma.

Child↗