PubMed Health⌕ Search

SEARCH · PubMed Health

Results for “Renorrhaphy”

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 19 recordsLinked to original sources
PubMed2026

Sutureless versus renorrhaphy in robot-assisted off-clamp partial nephrectomy: a systematic review and meta-analysis.

BACKGROUND: The necessity of routine parenchymal renorrhaphy during off-clamp robot-assisted partial nephrectomy (RAPN) remains uncertain. This study aimed to compare perioperative, functional, safety, and oncological outcomes between sutureless and conventional renorrhaphy. METHODS: We conducted a systematic review and meta-analysis following PRISMA 2020 guidelines. Comparative studies evaluating sutureless versus conventional renorrhaphy during purely off-clamp RAPN were included. Trifecta achievement was the primary outcome. Random-effects models were used for pooled analyses, with subgroup analysis according to study design. RESULTS: Four studies involving 787 patients, including one randomized controlled trial (RCT) and three propensity score-matched (PSM) studies, were included. The overall pooled estimate showed no statistically significant difference in Trifecta achievement (RR 1.17, 95% CI 0.97-1.41), with substantial heterogeneity (I² = 86.5%). The PSM studies favored the sutureless approach (RR 1.26, 95% CI 1.05-1.52), whereas the RCT yielded an RR of 0.97 (95% CI 0.92-1.04) and met the prespecified noninferiority criterion without demonstrating superiority. The sutureless approach was associated with a smaller perioperative eGFR decline (MD - 3.89, 95% CI - 6.16 to - 1.62), while no significant difference was observed in eGFR at 3 months. No statistically significant differences were identified in major complications, blood transfusion, or positive surgical margins; urinary and vascular complications were sparsely reported. CONCLUSIONS: In selected patients undergoing purely off-clamp RAPN, randomized evidence supports the noninferiority of a strategy that omits routine parenchymal renorrhaphy while permitting clinically necessary selective repair, but does not demonstrate superiority. Favorable estimates from PSM studies remain vulnerable to intraoperative treatment-selection bias. Current evidence is insufficient to determine whether omission of renorrhaphy affects urinary complications, long-term renal function, or oncological outcomes. REGISTRATION: This systematic review was registered prospectively in PROSPERO (CRD420261435995).

Humans↗
PubMed1987

Renorrhaphy using knitted polyglycolic acid mesh.

Surgical techniques for treatment of penetrating trauma to the kidney have ranged from simple drainage to nephrectomy, depending on the severity of the injury. Based upon successful experience in the surgical management of splenic injuries using knitted polyglycolic acid mesh, we report a case in which absorbable mesh was used to repair a laceration of the kidney.

Adolescent↗
PubMed1990

Renorrhaphy with a polyglycolic acid mesh.

In recent years resorbable polyglycolic acid mesh has been successfully used in the treatment of splenic injuries. The use of a resorbable mesh seems promising also in the treatment of renal injuries and in the rare ruptures of renal allografts. The authors report their own experience in the use of resorbable polyglycolic acid mesh in the treatment of a renal injury.

Child↗
PubMed1987

Renal failure and mortality after nephrectomy for severe trauma in multiply-injured patient: no inordinate risk.

It was recently reported that renal loss by partial or total nephrectomy for renal trauma increases the rates of acute renal failure and death in the multiply-injured patient. Because our preference has been for immediate surgical intervention in such patients, a retrospective review was performed to ascertain the effect of partial or total nephrectomy. Eighty-eight patients met the criteria of multiple injuries including severe renal injuries (laceration, rupture, or pedicle injury) and availability of renal function data. Partial or total nephrectomy had been performed in 50 patients, renorrhaphy in 23, and 15 were managed without renal operation. In patients with renal lacerations, the numbers of associated injuries (including intra-abdominal injuries) were similar to those managed conservatively or by operation, and the rates of acute renal failure and mortality were the same with conservative management, renorrhaphy, or nephrectomy. Patients with renal pedicle injuries who had a nephrectomy did have a higher rate of acute renal failure than those managed conservatively (75% vs 0%; p less than 0.05), but they also had more associated injuries (2.8 vs. 1.6/patient; p less than 0.04) and they were older. These two factors, rather than the nephrectomy, probably accounted for the greater rates of acute renal failure and death.

Acute Kidney Injury↗
PubMed1991

Intraoperative decision-making in renal trauma surgery.

Surgery for renal trauma requires three intraoperative decisions: Should the kidney be explored? Is pedicle control necessary? What procedure should be performed? In 85 explorations for penetrating (66) and blunt (19) trauma, we found that penetrating injuries, active hemorrhage, or major tissue destruction are reasons for mandatory renal exploration. This resulted in 26 nephrectomies, 9 partial nephrectomies, and 4 major renorrhaphies. Forty-six patients underwent minor renorrhaphy or needless exploration without complications. Formal pedicle control was carried out 33 times (39%), but it was never necessary to control parenchymal hemorrhage. Unless a wound overlies the great vessels, perirenal hematomas can be safely entered laterally without prior pedicle control using manual pedicle or parenchymal control if needed.

Adolescent↗
PubMed2001

Management of major blunt renal lacerations: is a nonoperative approach indicated?

OBJECTIVES: The aim of the study was to determine whether a nonoperative approach is able to reduce renal parenchymal loss after renal trauma. METHODS: Sixty-four consecutive patients with major blunt renal lacerations were treated from 1988 to 1999. Initial management was conservative. In group 1 (35 patients) delayed hemorrhage, persistent urinoma or hemodynamic instability were dealt with by open surgery. In group 2 (29 patients), most complications were dealt with using endoscopic procedures; open surgery was reserved exclusively for major complications. RESULTS: In group 1, 7 patients were not operated and 28 patients were managed surgically. Twenty (57%) patients underwent total (8) or partial (12) nephrectomy. In 8 patients the surgical intervention was open drainage of perinephric collection (6) and/or renorrhaphies (2). Four patients in this group developed urinary fistulae treated successfully with ureteral stents. Length of hospital stay was 9.6 days (3-25 days). In group 2, persistent hemodynamic instability led to nephrectomy in 1 case. The remaining 28 patients were managed conservatively, with endoscopic ureteric stenting in 5 cases. A persistent urinary extravasation with hyperthermia led to open drainage of perinephric urinoma (5) and renorrhaphy (2). No delayed nephrectomy was necessary. Average hospital stay was 12 days (5-21 days). Only 1 patient in this group developed hypertension. CONCLUSION: For most patients and with close follow-up available, conservative treatment represents a real alternative to open surgery in major blunt renal lacerations. In our experience, open surgery usually results in loss of renal parenchyma.

Adolescent↗
PubMed1996

Management of major blunt renal lacerations: surgical or nonoperative approach?

OBJECTIVE: To evaluate changes in the management of major blunt renal trauma since the introduction of computerized tomographic diagnosis and follow-up. MATERIAL AND METHODS: Twenty-three consecutive patients with deep blunt renal lacerations without major pedicle injury or shattered kidney were treated from 1986 to 1995. In group 1 (1986-1989, 12 patients), initial management was conservative, but with open surgery in cases of hemodynamic instability or persistent urinary extravasation. In group 2 (1990-1995, 11 patients), a plain conservative approach was followed and open surgery was reserved for major complications only. RESULTS: In group 1, 6 patients required early renal exploration (4 nephrectomies, 2 renorrhaphies). A persistent urinary fistula led to late nephrectomy in 1 of the renorrhaphy patients. Retroperitoneal hematoma and urinary extravasation spontaneously resolved in 6 cases. Length of hospital stay was significantly lower (p = 0.02) for nonoperated patients. None suffered from hypertension at long-term follow-up (5-8 years, mean 7.2). In groups 2, all 11 patients were treated conservatively, with endoscopic ureteric stenting in 4 cases. Urinary extravasation always resolved, but 9 patients had residual perirenal hematoma at the time of discharge. Length of hospital stay was significantly higher (p = 0.0005) with ureteric stenting. Nine months after trauma, 1 patient suffered from recurrent pyelonephritis. Radiographic follow-up (1-30 months, mean 10.2) revealed minor sequelae in all evaluated patients. CONCLUSION: In most patients with major blunt renal lacerations, a conservative approach is safe. Most extravasation spontaneously resolves and minimally invasive techniques will deal with nearly all complications. In our experience, open surgery usually results in nephrectomy.

Adolescent↗
PubMed2001

Grade IV renal injuries: evaluation, treatment, and outcome.

Of our last 2483 renal trauma patients, 113 had grade IV injuries. In most the mechanism was a penetrating injury (60%: 30% gunshot, 30% stab wounds). Associated injuries were common (80%) and hospital stays prolonged, averaging 16 days. Most of the patients (70%) required transfusion, some massively (average volume 4.4 liters, range 0-30 liters). Surprisingly, not all patients with grade IV renal injuries had gross hematuria: 25% had microhematuria, and 4% had neither microscopic nor gross hematuria. Computed tomography (CT) diagnosed the injury correctly in 100% of the patients in whom it was performed; when CT was not available, "one-shot" intraoperative intravenous pyelography (IVP) demonstrated grossly abnormal findings in 90%. Renal exploration was performed in 78%, resulting in 69% renorrhaphy and 9% nephrectomy rates in our 113 patients. Almost all those with penetrating trauma required exploration (97%), whereas only 50% of those with blunt trauma did so. The overall complication rate and kidney-specific complication rate did not differ significantly between patients who were observed and those who underwent surgery. Complications rates were similar in grade IV renal laceration patients and grade III patients. Delayed complications after hospital discharge were not seen, although follow-up was rare in this inner-city trauma population. Among the 21% of patients in whom postoperative nucleotide renal function scans were available, function was generally good (average 36%). Only patients who underwent concomitant vascular repair had poor function (below 20%).

Abdominal Injuries↗
PubMed1993

Use of biodegradable (PGA) fabric for repair of solid organ injury: a combined institution experience.

A fabric constructed of biodegradable mesh was used in the operative repair of injured intra-abdominal organs in 60 patients at two Level I Trauma Centres. Splenorrhaphy was performed in 44 patients, hepatorrhaphy in eight, renorrhaphy in five and one combined repair of spleen and liver and one kidney and liver. The age range for the patients was 5 to 61 years. Multiple-organ injury occurred in 21 patients. Mean emergency room systolic BP for the patient series was 120 +/- 24 mmHg (SD), Glasgow Coma Scale 14.3 +/- 1.9, haematocrit 37.2 +/- 6.4 per cent, Injury Severity Score (ISS) 28.1 +/- 16.3, Abdominal Trauma Index (ATI) 15.5 +/- 7.5. Postoperative complications occurred in 36.7 per cent of patients. Time for the operation averaged 165.1 + 72.1 min and preoperative and operative transfusion volume averaged 2248 ml. There were three deaths (5.4 per cent). The mesh organ repair technique is an alternative to conventional surgical procedures used to control bleeding from injured organ surfaces and to close organ parenchymal defects.

Abdominal Injuries↗
PubMed2005

Improved hemostasis during laparoscopic partial nephrectomy using gelatin matrix thrombin sealant.

OBJECTIVES: To evaluate whether using a biologic hemostatic sealant facilitates hemostasis during laparoscopic partial nephrectomy. Secure and durable parenchymal hemostasis is a critical requirement during laparoscopic partial nephrectomy. METHODS: Since September 1999, laparoscopic partial nephrectomy has been performed in more than 300 patients by a single surgeon, duplicating open surgical principles. Recently, from patient 225 onward, we modified our technique by incorporating topical application of a gelatin matrix thrombin sealant (FloSeal) to cover the partial nephrectomy bed before sutured renorrhaphy over a Surgicel bolster. The impact of FloSeal on reducing hemorrhagic complications was evaluated by comparing two sequential groups of patients: group 1 consisted of 68 patients in whom FloSeal was not used (patients 156 to 224) and group 2 consisted of 63 patients in whom it was used (patients 225 to 288). RESULTS: Groups 1 (no FloSeal) and 2 (FloSeal) were comparable in tumor size, number of central tumors, and performance of pelvicaliceal suture repair (84% versus 92%; P = 0.16). Intraoperative variables were also comparable in terms of mean warm ischemia time (36.1 versus 37.2 minutes; P = 0.55), blood loss (150 versus 106 mL; P = 0.36), operative time, and hospital stay. However, the FloSeal group had significantly fewer overall complications (37% versus 16%; P = 0.008) and tended toward a lower rate of hemorrhagic complications (12% versus 3%), although this did not achieve statistical significance (P = 0.08). CONCLUSIONS: The results of this study have shown that adjunctive use of gelatin matrix thrombin sealant substantially enhances parenchymal hemostasis and has decreased our procedural and hemorrhagic complications to levels comparable with contemporary open partial nephrectomy series. This gelatin matrix-thrombin tissue sealant is now a routine part of laparoscopic partial nephrectomy at our institution.

Gelatin Sponge, Absorbable↗
PubMed2006

Pediatric blunt renal trauma: its conservative management and patterns of associated injuries.

OBJECTIVES: To review the conservative management of pediatric renal trauma and investigate the significance of associated nonrenal injuries. METHODS: We performed a retrospective review of 63 pediatric patients with blunt renal injury who were treated expectantly. A comparison was made between operative and nonoperative management, mechanism of injury, treatment complications, requirement for blood transfusion, length of hospital stay, associated injuries, and incidence of pre-existing urologic conditions. RESULTS: The renal injury grade was grade I in 31 patients, grade II in 12, grade III in 8, grade IV in 10, and grade V in 2. Two patients underwent acute surgical exploration; one for nonrenal causes and one (2%) for life-threatening renal bleeding (grade V injury). Renorrhaphy was not performed, and 98% of patients were initially treated nonoperatively. Three patients (5%) underwent delayed renal surgery: one nephrectomy for Wilms' tumor, one partial nephrectomy for nonhealing grade IV injury, and one attempted repair of a renal pelvis injury with subsequent nephrectomy. Excluding 1 patient who died and one nephrectomy for tumor control, our renal salvage rate was 97% (59 of 61). The overall mean hospital stay was 7.7 days and was similar across all grades (grade I, 7.7 days; grade II, 7.8; grade III, 6.1; grade IV, 9.2; and grade V, 10.5 days). CONCLUSIONS: The results of our study have shown that pediatric patients with blunt nonexsanguinating renal injuries treated conservatively do well. The length of hospital stay did not increase with worsening severity of renal injury and, instead, was determined by the severity of the nonrenal associated injuries. This report adds to a growing body of published data that suggest that conservative management of pediatric blunt renal trauma is safe.

Adolescent↗
PubMed1991

Renal reconstruction after injury.

During an 11-year period 1,363 patients presented to our institution with renal trauma. Renal exploration was performed in 127 patients (133 renal units). Most patients had multiple organ injuries, as indicated by a mean blood loss of 4,160 ml. and a mean injury severity score of 25.8. Absolute indications for exploration were bleeding and pulsatile perirenal hematoma and relative indications included urinary extravasation, nonviable renal tissue and incomplete staging. Renal surgery was required in 2.4% of the blunt injuries, 45% of the stab wounds and 76% of the gunshot wounds. Salvage was successful in 88.7% of the kidneys explored and total nephrectomy was required in 11.3%. The success rate was based on early vascular control and reconstructive techniques of "renorrhaphy," partial nephrectomy, vascular repair and coverage with omental pedicle flaps. Complications occurred in 9.9% of the cases but none resulted in renal loss. When indicated, renal exploration after trauma is safe and in a high percentage of cases reconstruction will be successful.

Adult↗
PubMed1977

Surgical management of major renal trauma: a review of 102 cases treated by conservative surgery.

A review is presented of 102 patients with significant renal trauma seen in the last 5 years. All patients underwent exploratory laparotomy for abdominal trauma and had associated urologic injuries, which were managed by conservative surgery. Forty-eight patients had non-expanding retroperitoneal hematoma and were treated expectantly. Nine patients needed exploration and drainage only, while 18 had some form of renorrhaphy. Four patients underwent repairs of renal pelvic injuries, 12 underwent partial nephrectomy and 11 underwent repairs of renal pedicle injuries. A conservative approach to renal trauma is emphasized.

Abdominal Injuries↗
PubMed1987

The effects of treatment of renal trauma on renal function.

Renal function studies were performed in 275 severely injured patients with hemorrhagic shock and massive transfusion. There were 230 patients without renal injury and 45 patients with renal injury treated without exploration of the kidney in 17 patients, with exploration and renorrhaphy in nine patients, and with partial or total nephrectomy in 19 patients. In addition, 45 patients without renal injury were randomly matched by computer to the 45 patients with renal injury based on the number of blood transfusions and severity of shock as indicators of physiologic insult. Renal function was adversely affected by partial or total nephrectomy in patients with renal injury. Significant decreases in renal filtration and excretion were seen when the nephrectomy group was compared to the patients without renal injury matched for injury insult. Creatinine clearance decreased from 103 ml/min to 55 ml/min, inulin clearance from 106 ml/min to 63 ml/min, and osmolar clearance from 4.8 ml/min to 3.3 ml/min. The 230 patients without renal injury had an incidence of renal failure of 7.4% and a mortality rate of 8.2% compared to 11.4% and 15.6%, respectively, in the 45 patients with renal injury. Death and renal failure occurred in 13 of the 230 patients without renal injury (5.6%) and in two of the 45 renal injury patients (4.4%). The incidence of renal failure in the 19 patients without renal injury who died was 68% versus 29% in the seven renal injury patients who died. Preservation of renal parenchyma is recommended to provide maximal renal function in severely injured patients.

Acute Kidney Injury↗
PubMed1999

Surgical management of renal trauma: is vascular control necessary?

OBJECTIVE: To assess in a randomized prospective manner nephrectomy rate, transfusion rate, blood loss, and time of operation in penetrating renal trauma patients randomized to vascular control or no vascular control before opening Gerota's fascia. METHOD: During a 53-month period from January of 1994 to May of 1998, 56 patients with penetrating renal injuries were entered into a randomized prospective study at an urban Level I trauma center. The patients were randomized to a preliminary vascular control group or no vascular control group. Randomization was performed intraoperatively before opening Gerota's fascia. All renal injuries were identified and diagnosed intraoperatively. Intravenous pyelography was not performed preoperatively. If the patient was randomized to the no control group and significant bleeding ensued after opening of Gerota's fascia, the renal hilum was cross-clamped. All injuries were included regardless of patient age, associated injuries, blood loss, severity of renal injury, or other abdominal organs injured. All injuries that required renorrhaphy or partial nephrectomy underwent drainage with closed Jackson-Pratt drainage. RESULTS: Twenty-nine patients were randomized to the preliminary vascular control group, and 27 patients were randomized to the no vascular control group. The average age in the vascular control group was 25.3 years (SD, 10.9) and 23.4 years (SD, 8.2) in the no control group. The average penetrating abdominal trauma index in the vascular control group was 22.9 (SD, 10.9) and in the no control group 23.7 (SD, 13.7). Nine nephrectomies (31%) were performed in the vascular control group, and eight nephrectomies (30%) were performed in the no vascular control group (p > 0.05). The average operative time for the vascular control group was 127 minutes and for the no control group was 113 minutes (p > 0.05). Eleven patients (38%) required intraoperative blood transfusion in the vascular control group (average, 5.5 U/patient transfused) versus eight patients (30%) in the no vascular control group (average, 5.2 U/patient transfused) (p > 0.05). The average blood loss in the vascular control group was 1.06 liters versus 0.91 liters in the no control (p > 0.05). There was one mortality in the study population. CONCLUSION: Vascular control of the renal hilum before opening Gerota's fascia has no impact on nephrectomy rate, transfusion requirements, or blood loss. Operative time may be increased with the vascular control technique.

Adult↗
PubMed2003

Effect of an institutional policy of nonoperative treatment of grades I to IV renal injuries.

PURPOSE: Nonoperative treatment of serious renal injuries has been advocated and yet to our knowledge the optimum level of operative treatment has not been established to date. We report a unique data set, in which patients with severe renal injuries were treated with an ultraconservative nonoperative approach during a period when urological consultation was not available at a major urban trauma center. MATERIALS AND METHODS: We retrospectively reviewed the charts of 51 patients identified with renal trauma in the Detroit Receiving Hospital trauma data base from 1997 to 2001. RESULTS: Injuries were grades I to V in 15, 7, 11, 14 and 4 cases, respectively, and had a tendency toward serious injury. Renorrhaphy was never performed. Nephrectomy was done sparingly, only for grade V renal injuries and only in patients who were exsanguinating from the kidney. Two of the 4 patients with grade V injury died of multiple injuries, including massive head injuries. Only 2 of the patients treated nonoperatively (4%) had complications, including fever and hematuria in 1 each. CONCLUSIONS: This data set seems to support an ultraconservative approach of limiting renal surgery to only patients with active exsanguination. The nephrectomy rate for 14 grade IV injuries, including some gunshot wounds to the kidney, was 0%. When comparing this rate with that in the literature, we would expect it to be 1 patient to as high as 10. This approach was safe and resulted in a low complication rate of 4%. Series in which more aggressive therapy for renal injuries is advocated should compare favorably to ultraconservative therapy if aggressive therapy is to continue to be widely advocated.

Adolescent↗
PubMed2004

Traumatic hematuria in children can be evaluated as in adults.

PURPOSE: Controversy exists regarding whether children who present with blunt abdominal trauma and microhematuria should undergo renal imaging. Adult blunt trauma victims who present without gross hematuria, shock, or significant deceleration or other major associated injuries do not require renal imaging. This study was designed to evaluate whether the criteria for imaging the renal parenchyma in adult blunt trauma victims apply to the pediatric population. MATERIALS AND METHODS: We retrospectively reviewed 720 consecutive pediatric patients with suspected renal trauma to determine mechanism of injury, evaluation and treatment of subsequent injuries. RESULTS: Of the 720 trauma patients with hematuria (mean age 8 years) 334 underwent imaging, and 59 renal injuries were identified (grade I 32, grade II 6, grade III 8, grade IV 12, grade V 1). A total of 11 patients underwent exploration, resulting in 3 nephrectomies (grade IV 2, grade V 1). Renorrhaphy was not necessary and all other cases were managed conservatively. All patients with significant renal injuries experienced either gross hematuria, shock (systolic blood pressure less than 90 mm Hg) or a significant deceleration injury. CONCLUSIONS: The decision to image pediatric trauma cases based on the adult criteria of gross hematuria, shock and significant deceleration injury is appropriate. Among 720 pediatric cases of potential renal injury all would have been identified.

Adolescent↗