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Results for “Nephrectomy”

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At least 1,243 records · Page 69Linked to original sources

PubMed1996

Laparoscopic nephrectomy via the retroperitoneal approach.

PURPOSE: We evaluated efficacy of the retroperitoneal approach for laparoscopic nephrectomy of kidneys with benign disease. MATERIALS AND METHODS: Eight men and 12 women (mean age 55 years) with severely damaged kidneys underwent laparoscopic retroperitoneal nephrectomy. One patient had a history of multiple open abdominal and gynecological operations. Kidneys were removed laparoscopically from the working space, which was created by finger and balloon dissection, and maintained by carbon dioxide insufflation in the retroperitoneal cavity. RESULTS: All kidneys were removed successfully via this procedure. Mean operative time was 3.3 hours and mean estimated blood loss was 135 ml. One patient experienced bleeding from the injured capsular artery just after removal of the kidney. CONCLUSIONS: The retroperitoneal approach is recommended for laparoscopic nephrectomy.

Adolescent↗

PubMed1996

Simple nephrectomy by retroperitoneoscope.

Retroperitoneoscopic simple nephrectomy was successfully performed in 10 of 12 patients with nonfunctioning kidneys. The other two patients underwent traditional open surgery. The surgical procedures, technical pitfalls, surgical results and perisurgical complications of this simple retroperitoneoscopic approach are described. Retroperitoneoscopic nephrectomy is a viable alternative for simple nephrectomy and has the benefits of minimal invasiveness, more rapid convalescence and better quality of life for patients.

Aged↗

PubMed1977

[State of the hemodynamics in the remaining kidney after nephrectomy].

The state of hemodynamics of the kidney left after nephrectomy was examined by determining renal blood flow and rheorenography. In the two experimental series nephrectomy was accompanied by hemorrhage with the subsequent auto-blood and homologous blood transfusion. Nephrectomy produced a blood flow reduction in the remaining kidney associated with the lowering of the blood compression and vasospasm. The blood flow returned to the normal at the end of the first 24 hours, and then increased progressively. Hemorrhage during the operation aggravated the hemodynamic disorders in the remaining kidney during the first postoperative hours. The use of autoblood promoted their quick disappearance, within two hours. At the same time the use of homologous blood led to persistence of hemodynamic disorders up to three days after the operation.

Animals↗

PubMed1997

[Synchronous bilateral renal cell carcinoma. Renal transplantation after nephrectomy].

INTRODUCTION: Treatment of bilateral and synchronous renal cell cancer may require bilateral nephrectomy and chronic dialysis. After an arbitrarily determined waiting period (2 years) on dialysis, kidney transplantation may be proposed. CASE REPORTS: Two patients underwent kidney transplantation after bilateral nephrectomy for early-stage low-grade renal cell cancer. Eight years after nephrectomy and 6 years after transplantation, there is no evidence of cancer recurrence and renal function is satisfactory. DISCUSSION: Certain patients treated for cancer may be candidates for kidney transplantation, even if the risk for cancer is higher in transplant recipients. Moreover, kidney transplantation without a required period on chronic dialysis could be proposed in early-stage lowgrade renal cell cancer.

Adult↗

PubMed1997

Laparoscopic radical nephrectomy: the Nagoya experience.

PURPOSE: We evaluated the efficacy of laparoscopic radical nephrectomy for removing kidneys with small volume renal cell carcinoma. MATERIALS AND METHODS: 25 patients (19 men and 6 women, mean age 59) who had a kidney with small volume renal cell carcinoma (diameter less than 5 cm.), underwent laparoscopic radical nephrectomy. The kidney was dissected laparoscopically together with the adrenal gland, perirenal fatty tissue and Gerota's fascia. In 11 patients, we used the transperitoneal approach and in the remaining 14 we used the retroperitoneal approach, in which a working space is created by finger and balloon dissection. We maneuvered the kidney into the laparoscopy sack, which was then removed through an additional 5 to 6 cm. incision. RESULTS: All 25 kidneys were removed successfully. Mean operation time was 5.3 hours and mean estimated blood loss was 335 ml. There were 5 complications, including a patient who suffered an injury to the duodenum, which was treated by open duodenojejunostomy. Full convalescence occurred at an average 23 days. No metastatic disease, no local recurrence and no seeding at the port sites occurred during the followup of 7 to 49 months (mean, 22 months). CONCLUSIONS: Laparoscopic radical nephrectomy is recommended as a minimally invasive procedure for removing kidneys with small volume renal cell carcinoma.

Adult↗

PubMed1996

Effect of probucol on mRNA expression of glomerular antioxidant enzymes in rat with subtotal nephrectomy.

OBJECTIVE: To investigate 1) the glomerular mRNA expression and protein activity of antioxidant enzymes (AOEs) including superoxide dismutase (SOD) and glutathine peroxidase (GSH-Px) and the glomerular content of lipid peroxide-malondiadehyde (MDA), 2) the effects of probucol (P), a potent antioxidant agent on these AOEs and MDA levels, in the chronic phase of subtotal nephrectomized rats. METHODS: The adult male Spregue-Dawley rats were randomly divided into three groups at the first week after subtotal renal ablation. Group 1 was sham rats (sham n = 8), group 2 underwent 5/6 nephrectomy without special therapy (5/6 Nx n = 8), and group 3 with 5/6 nephrectomy received probucol (5/6 Nxs+P n = 8) at a dose of 1% in the rat chow. At the 12th week after P was administrated, all of the rats were sacrificed to remove left kidney for the determination of glomerular level of MDA, activity of SOD, and GSH-Px, glomerular mRNA expression of AOEs by Northern blot analysis as well as a histological examination. RESULTS: In 5/6 Nx, serum cholesterol, proteinuria increased and creatinine clearance decreased progressively with age as compared with that in sham. Those abnormalities as well as glomerulosclerosis index (GI) ameliorated with the administration of probucol at the 12th week after subtotal nephrectomy [GI: sham 3.12 +/- 1.20, P < 0.01 vs 5/6 Nx 5/6 Nx 188.6 +/- 25.1; 5/6 Nx +/- P, 106.9 +/- 17.6, P < 0.05 vs 5/6 Nx]. The probucol therapy also significantly improved the decrease of glomerular Mn-SOD and GSH-Px both at mRNA level and protein activity and the increase of glomerular MDA content. CONCLUSIONS: We demonstrated a deficiency of glomerular AOEs in the chronic phase of remnant kidney, which may contribute to the progression of renal injury. The protective effects of probucol on both renal functional impairment and the development of glomerulosclerosis may be partially associated with improving surviving glomerular AOEs.

Animals↗

PubMed1997

Potential for bilateral nephrectomy to reduce oxalate release after combined liver and kidney transplantation for primary hyperoxaluria type 1.

Primary hyperoxaluria type 1 (PH-1) is frequently associated with end stage renal failure due to urinary calculi, obstructive uropathy and interstitial deposits of calcium oxalate. The currently accepted treatment for PH-1 is liver transplantation to replace the deficient enzyme peroxisomal alanine glycoxylate aminotransferase (AGT) and a simultaneous renal transplant to restore renal function. The transplanted kidney may become significantly impaired or fail when systemic calcium oxalate is eliminated by renal excretion. The native kidneys are a major source of this oxalate. This study was undertaken to determine whether there is a difference in oxalate clearance following combined liver-kidney transplant in patients with PH-1 by comparing the effect of native kidney nephrectomy at the time of transplantation against leaving the native kidneys in situ. Regression analysis was used to compare daily urinary oxalate excretion corrected for body surface area. There was a significant reduction in urinary oxalate excretion (P < 0.05) in the patient who had undergone bilateral nephrectomy compared to the patient whose native kidneys remained in situ for the first 100 d following combined liver and kidney transplantation. No difference was observed in the serum oxalate levels between patients over the same period or in the renal function assessed by creatinine clearance corrected for body surface area. Total body oxalate load was not determined in this study. A larger study should be undertaken to examine the benefits of nephrectomy in reducing oxalate deposition in recently inserted allografts for patients with PH-1.

Adult↗

PubMedDate not supplied

[Partial nephrectomy for renal cancer in patients with a normal contralateral kidney].

There has been a growing interest over the last few years in partial nephrectomy as the elective surgery for renal cancer in selected groups of patients with normal contralateral kidney. Between July 1990 and April 1996, 14 partial nephrectomies were performed in our service in patients with presumed diagnosis of renal cancer and normal contralateral kidney 10 of which had histological diagnosis of renal carcinoma and 4 showed absence of malignancy. From the analysis and discussion of these cases it can be deduced: 1) partial nephrectomy in selected groups of patients is an oncologically valid technique; 2) computerized tomography is a highly sensitive method for detection of renal cancer carrier patients, although it presents low specificity, mainly in small tumours, resulting in a number of false positive cases that must be considered when deciding the surgical technique; 3) tumour topography should not exclude conservative surgery of the kidney; 4) patients should be available for follow-up.

Adult↗

PubMed2001

Hand-assisted laparoscopic live donor nephrectomy in a patient with renal artery aneurysm.

Among the transplantation teams there is an increasing interest in laparoscopic live donor nephrectomy. For technical reasons, the use of the left kidney is recommended. However, considering the shortage of organ donors, it is likely that right-side laparoscopic live donor nephrectomy will need to be considered in selected donors, even those with vascular anomalies. Here we report the first case of right-side live donor laparoscopic nephrectomy in a patient with a renal artery aneurysm. Arteriography showed a 3-cm saccular aneurysm of the main right renal artery located at the bifurcation of the secondary branches and associated with an inferior polar artery coming directly from the aorta. The patient was placed in the lumbotomy position. An 8-cm midline incision was made above the umbilicus to insert the HandPort system (Smith & Nephew S.A., 72019 Le Mans Cedex2, France). Four additional trocars were introduced. Dissection of the renal artery was carried out beyond the level of relieving the aneurysm behind the vena cava. The main and polar arteries were clipped, and the renal vein was stapled. The kidney was removed through the HandPort and perfused cold ex vivo. The warm ischemia time for the kidney was 1 min, and the total operative time was 280 min. Vascular abnomalies were corrected ex vivo. The postoperative course of the donor was uneventful. At 6 months after transplantation, the graft function was normal. The hand-assisted approach is of particular value on the right side where the dissection must be carried out behind the vena cava. The HandPort may save few precious minutes over the sac extraction technique of the standard laparoscopic procedure.

Journal Article↗

PubMed2003

Isolated local recurrence of renal cell carcinoma after radical nephrectomy: experience with 10 cases.

OBJECTIVES: Isolated local recurrence of renal cell carcinoma after radical nephrectomy is very uncommon and the effect of aggressive surgical management of this clinical entity remains controversial. We report our experience with 10 such cases. METHODS: Between 1994 and 2002, 10 patients with isolated local recurrence of renal cell carcinoma without any evidence of metastatic disease after radical nephrectomy were treated at our department. The mean patient age was 51.7 years (range 26 to 74); 7 patients were men and 3 were women. All patients underwent extensive surgery for local recurrence. RESULTS: Only 3 patients were symptomatic, and the others were diagnosed during routine follow-up examinations. The mean time to local recurrence was 33.6 months (range 3 to 68), and the mean size of the recurrent tumor was 8.45 cm (range 3 to 12). An aggressive surgical approach was taken in all patients. One patient died in the postoperative period because of a surgical complication. Of the remaining 9 patients, 2 died of metastatic disease after a mean survival of 8.5 months (range 3 to 14). Seven patients were alive with a mean survival of 16.6 months (range 3 to 38+). CONCLUSIONS: We believe that patients with isolated local recurrence after radical nephrectomy may benefit from an aggressive surgical approach, but this kind of surgery may also have significant complications.

Adult↗

PubMed2003

Retransplantation after kidney graft loss due to polyoma BK virus nephropathy: successful outcome without original allograft nephrectomy.

Although polyoma BK virus (BKV)-associated interstitial nephritis has received increasing attention because of its clinical relevance in kidney allograft recipients, data on risk for repeated renal transplantation after BKV-related allograft loss are limited, and the need to perform an original graft nephrectomy is the object of debate. A 15-year-old boy with renal failure secondary to Alport's syndrome underwent renal transplantation. His posttransplantation course was complicated by acute rejection episodes and the presence of circulating anti-glomerular basement membrane antibodies that required aggressive immunosuppressive treatment. Graft failure caused by BKV-associated interstitial nephropathy occurred despite a reduction in immunosuppression and cidofovir treatment. The patient received a second transplant without an original graft nephrectomy, and 15 months after retransplantation, he persists with optimal graft function and is constantly BKV DNA negative in both urine and plasma. Our report indicates that an original allograft nephrectomy may not be mandatory for successful retransplantation after graft loss caused by BKV nephropathy.

Acute Disease↗

PubMed2002

Retroperitoneal laparoscopic hand-assisted live-donor nephrectomy: our initial experience.

Since the introduction of the hand port in laparoscopic surgery 4 years ago, only a few articles have appeared in the medical literature discussing its use in live-donor nephrectomy. None of these procedures was performed by the retroperitoneal laparoscopic approach. This paper presents our initial experience of three hand-assisted retroperitoneoscopic live-donor nephrectomies. The procedure was performed with the patient in a lateral position, using a total of three ports: a hand port, camera port and working port. The surgeon, standing at the front, made the hand-port incision in the anterior abdominal wall and deepened it down to the parietal peritoneum, by either splitting or dividing the muscles. Once the retroperitoneal space had been dissected down to the kidney and the ureter, the surgeon moved to the back of the patient. The procedure was successful in all three patients and there were no complications in either the donors or recipients, with a mean follow-up of 10 weeks. The surgeon was seated comfortably throughout the procedure, with the hand-port arm resting on the pelvis of the patient. The mean operative time was 118 min. The mean estimated blood loss was 50 mL and the warm ischaemia time 92 s. Retroperitoneal laparoscopic hand-assisted donor nephrectomy is a viable alternative for those who prefer the extraperitoneal approach for their laparoscopic procedures.

Journal Article↗

PubMed2004

Laparoscopic nephrectomy for wilms tumor after chemotherapy: initial experience.

PURPOSE: We describe 2 cases of laparoscopic nephrectomy for unilateral Wilms tumor in children who underwent preoperative chemotherapy. MATERIALS AND METHODS: Two children with unilateral nonmetastatic Wilms tumor included in the International Society of Pediatric Oncology 2001 protocol were preoperatively treated with vincristine/actinomycin D and subsequently underwent laparoscopic nephrectomy and lymph node sampling. A 5 and 10 mm trocar transperitoneal approach was used in each case. The tumor was extracted without morcellation through a 4 cm Pffannensteil incision. RESULTS: The 2 tumors were completely removed as well as lymph node samples. Intraoperative bleeding was minimal (50 ml). The postoperative period was free of complications and patients were discharged home after 3 days. CONCLUSIONS: Laparoscopic nephrectomy for Wilms tumor is feasible in children after chemotherapy. It is a safe procedure and it allows the complete surgical approach required to treat this tumor. Longer followup is necessary to evaluate long-term results and more cases are necessary to compare the results of laparoscopic techniques with those of open surgical procedures.

Antineoplastic Combined Chemotherapy Protocols↗

PubMedDate not supplied

Surgical treatment of metachronous metastases in different organs following radical nephrectomy.

UNLABELLED: Renal clear cell carcinoma (RCCC) is a neoplasia resistant to radio and chemotherapy, with surgical treatment being the procedure that is recognized for its curative treatment. This case report demonstrates the success of an aggressive surgical treatment for consecutive and late metachronous metastases following radical nephrectomy. CASE REPORT: Asymptomatic 50-year old man. During a routine examination, an incidental mass was found by renal ultrasonography. He underwent right radical nephrectomy due to RCCC in June 1992. During the follow-up metastases were evidenced in cerebellum on the seventh year, and in left lung and pancreas on the eighth year following the radical nephrectomy, with all of them successfully treated by surgical excision. COMMENTS: The surgical excision of consecutive and late metachronous metastases in different organs arising from RCCC is feasible, being a good therapeutic alternative in selected cases.

Journal Article↗

PubMed1999

Living donor nephrectomy: follow-up renal function, blood pressure, and urine protein excretion.

PURPOSE: To assess the effect of donor nephrectomy on blood pressure, 24-hour urine protein excretion, and renal function. MATERIALS AND METHODS: Of the 198 individuals who donated a kidney between 1991-1996, 101 had their blood pressure, 24-hour urine protein excretion, and serum creatinine concentration levels measured. The mean duration of follow-up was 3.2 +/- 1.6 years (range: 8.5 months to 6.5 years). RESULTS: Serum creatinine concentration was significantly higher (p<.001) at follow-up (107 +/- 20 umol/L) compared to before donation (86 +/- 18 umol/L). When follow-up serum creatinine concentrations were expressed as percentages of their pre-operative values, a gradual decline was observed with time (R= -.380). Diastolic blood pressures (p<.05) and 24-hour urine protein levels (p<.001) were significantly higher at follow-up, however, neither increased with time. The prevalence of hypertension and proteinuria in our donors was no different from that of the general population. CONCLUSIONS: Donor nephrectomy does not impair renal function or result in a progressive rise in blood pressure or urine protein excretion up to 6.5 years after nephrectomy.

Journal Article↗

PubMed2006

Surveillance strategies for renal cell carcinoma patients following nephrectomy.

Renal cell carcinoma (RCC) is the most lethal of urologic malignancies, accounting for an estimated 36,000 new cases of carcinoma and 12,000 deaths in 2005. Nephrectomy is the usual treatment; however, after nephrectomy, RCC recurs in 20% to 40% of patients with clinically localized disease. A consensus surveillance protocol does not exist for follow-up of RCC after nephrectomy. In this article, available protocols are reviewed with a goal of developing an evidence-based system including the prognostic factors for recurrent disease, chronology and sites of recurrence, available treatment options if recurrent disease is found, and modalities of diagnostic testing available to urologists. New surveillance recommendations are presented based on prognostic factors as well as the University of California, Los Angeles Integrated Staging System for RCC.

Journal Article↗

PubMed2002

Early and late recipient graft function and donor outcome after laparoscopic vs open adult live donor nephrectomy for pediatric renal transplantation.

BACKGROUND: Laparoscopically procured live donor kidney grafts are increasingly transplanted into pediatric recipients. The safety and efficacy of this changed surgical practice are unknown. HYPOTHESIS: Outcomes of laparoscopic vs open donor grafts in recipients 18 years and younger are equivalent. DESIGN AND SETTING: Retrospective review at an academic tertiary care referral center. PATIENTS: Eleven consecutive pediatric recipients of laparoscopically procured kidneys between April 1, 1997, and December 31, 2001, were pair matched for age with 11 recipients of openly procured kidneys between December 1, 1991, and March 31, 1997; the 22 adult donors were also studied. MAIN OUTCOME MEASURES: Recipients: surgical complications, graft function and survival. Donors: perioperative morbidity and length of hospital stay. RESULTS: Twenty (91%) of 22 kidneys were donated by a parent of the recipient. In recipients of laparoscopically procured grafts, we observed significantly lower creatinine clearances and higher creatinine levels on days 1, 4, and 6, but by 1 month, graft function was similar in both groups. No significant differences in surgical complications, delayed function, acute and chronic rejection, and graft survival rates were found. No laparoscopic or open donor required blood transfusion, reoperation, or hospital readmission. One laparoscopic donor (9%) was converted to open nephrectomy. For laparoscopic vs open donors, median operative time was longer (difference, 67 min; P =.08), but median postoperative length of stay was significantly shorter (3 vs 5 days; P =.02). CONCLUSIONS: Laparoscopic live donor nephrectomy has no adverse impact on pediatric recipient outcomes. For donors, the laparoscopic operation is safe and the hospital stay is shortened. These results support the continued use of laparoscopically procured live donor kidneys in pediatric renal transplantation.

Adolescent↗

PubMed1975

Unilateral "Page kidney" hypertension in man. Studies of the renin-angiotensin-aldosterone system before and after nephrectomy.

Hypertension developed in a 17-year-old boy one year after a flank injury. Intravenous pyelography showed a slightly smaller kidney on the injured side. Renal arteriography demonstrated unilateral decreased vascular filling. Renal vein ratios suggested an ischemic kidney, as did split-function studies. Nephrectomy cured the hypertension. Detailed studies before and after nephrectomy suggested that hyperactivity of the renin-angiotensin-aldosterone system may participate in the pathophysiology of this unusual cause of hypertension in man.

Adolescent↗