[45] Role of nephrometry scoring systems (R.E.N.A.L.-PADUA) in planning nephron-sparing surgery in patients with renal masses: Retrospective study of 88 cases

e16139 Background: To present our experience with elective, open, nephron-sparing surgery for renal masses in a contemporary, consecutive series. Methods: In this retrospective study, records of all patients who underwent elective nephron-sparing surgery (E-NSS) between March 1997 and December 2007 at our institution were reviewed. The preoperative workup included laboratory analysis, renal ultrasonography and abdominal computed tomography. The histological findings, complications, and oncologic outcome were studied. Results: A total of 231 E-NSS were performed in 223 patients (82 females,141males; mean age 64 years). 62 “hot ischemia” procedures and 169 “cold ischemia”. The mean tumor size was 4.6 cm (1.1–12cm). 52 patients presented renal masses > 4cm. Renal cell carcinoma was present in 177 patients (76.6%), benign renal masses were diagnosed in in 54 pazienti (23.3%): angiomyolipoma (35%), oncocytoma (40%), complicated cyst (25%). Worthy of note among these 54 patients, pre-operative diagnosis was present in 12 patients. Moreover, 17 benign lesions (31%) were > 4 cm. Complication rate was 5.3% (12 pts): splenectomy (2.2%), nephrectomy because of postoperative bleeding (0.8%), urinary fistulas (0.8%). After a median follow-up of 84 months (range 5 to 120), no patient had developed local recurrence, 19 (8.9%) died for other causes, 2 (0.9%) died for other tumor. Conclusions: The results of this contemporary, monocenter experience underline the role of open, elective, nephron-sparing surgery for patients with renal masses, confirming good results even for renal masses > 4cm. These conclusions are particularly important considering that benign histologic findings were present in almost one forth of patients. No significant financial relationships to disclose.

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The role of percutaneous fine needle aspiration biopsy in the management of small renal masses without chance of nephron-sparing surgery

International Urology and Nephrology ◽

10.1007/s11255-020-02558-z ◽

2020 ◽

Vol 52 (12) ◽

pp. 2223-2228

Author(s):

Wei Tong ◽

Xianwen Lin ◽

Yizhi Xu ◽

Yi Yan

Keyword(s):

Fine Needle Aspiration ◽

Fine Needle Aspiration Biopsy ◽

Needle Aspiration ◽

Nephron Sparing Surgery ◽

Aspiration Biopsy ◽

Small Renal Masses ◽

Renal Masses ◽

Fine Needle ◽

Nephron Sparing

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A comparison of DAP and RENAL scoring systems in the achievement of trifecta in laparoscopic partial nephrectomy

Urologia Journal ◽

10.1177/03915603211019981 ◽

2021 ◽

pp. 039156032110199

Author(s):

Sumanta Kumar Mishra ◽

Ranil Johann Boaz ◽

Sudhindra Jayasimha ◽

Rajiv Paul Mukha ◽

Nitin Sudhakar Kekre ◽

...

Keyword(s):

Partial Nephrectomy ◽

Scoring System ◽

Scoring Systems ◽

Small Renal Masses ◽

Renal Masses ◽

Upper Limits ◽

Nephron Sparing ◽

Invasive Techniques ◽

Warm Ischaemia Time

Purpose: The concept of ‘trifecta’ outcome postulated for radical prostatectomy has been adopted for partial nephrectomy, the gold standard for management of small renal masses. We sought to evaluate the role of nephrometry scores in predicting outcomes in terms of the trifecta. We compared two scoring systems for renal tumour complexity (RENAL and DAP) in the prediction of trifecta outcomes. Materials and methods: Sixty-nine patients who underwent laparoscopic PN (LPN) were evaluated in a single-centre retrospective study (2010–2017). RENAL and DAP scores were measured. Parameters relevant to the trifecta were tabulated. Results: When comparing the two scoring systems in terms of warm ischaemia time (WIT), the DAP score could predict with statistically significant accuracy the completion of resection within 25 mins of WIT. Tumours were more evenly distributed according to anatomical characteristics with the DAP scoring system than with the RENAL scoring system. When comparing these systems in terms of complications, neither predicted complications based on complexity with significant accuracy. A low RENAL score predicted trifecta achievement in three-fourth (71.4%) of patients, while a medium RENAL score predicted trifecta achievement in half (54%) of patients. DAP score predicted trifecta achievement in all tumours with a low score, two-third (66%) in medium and less than half (42%) with a high score. Predictions based on DAP were accurate and significantly so ( p = 0.024). Conclusions: DAP score predicted the outcomes of LPN in terms of trifecta significantly better than the RENAL score. In our experience, the DAP score was able to distribute tumour complexity among its groups more effectively than the RENAL score. There is early evidence that the DAP score may be more useful than the RENAL score for decision-making in nephron sparing surgery. This is especially pertinent for small renal masses at the upper limits of tumour complexity for which minimally invasive techniques can be safely applied.

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