388 COST-UTILITY OF RADICAL NEPHRECTOMY VERSUS PARTIAL NEPHRECTOMY IN THE MANAGEMENT OF SMALL RENAL MASSES: ADJUSTING FOR THE BURDEN OF CHRONIC RENAL FAILURE

2011 ◽  
Vol 185 (4S) ◽  
Author(s):  
Zachary Klinghoffer ◽  
Anil Kapoor ◽  
Luis H. Braga
Keyword(s):  
Renal Failure ◽  
Chronic Renal Failure ◽  
Partial Nephrectomy ◽  
Radical Nephrectomy ◽  
Cost Utility ◽  
Small Renal Masses ◽  
Renal Masses

scholarly journals Cost-utility analysis of radical nephrectomy versus partial nephrectomy in the management of small renal masses: adjusting for the burden of ensuing chronic kidney disease

2013 ◽  
Vol 7 (3-4) ◽  
pp. 108-13 ◽  
Author(s):  
Zachary Klinghoffer ◽  
Jean-Eric Tarride ◽  
Giacomo Novara ◽  
Vincenzo Ficarra ◽  
Anil Kapoor ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Partial Nephrectomy ◽  
Radical Nephrectomy ◽  
Cost Utility ◽  
Sensitivity Analyses ◽  
Decision Analysis Model ◽  
Complication Rates ◽  
Small Renal Masses ◽  
Renal Masses

Objectives: To compare the cost-utility of laparoscopic radical nephrectomy (LRN), laparoscopic partial nephrectomy (LPN) and open partial nephrectomy (OPN) in the management of small renal masses (SRMs) when the impact of ensuing chronic kidney disease (CKD) disease is considered. Methods: We designed a Markov decision analysis model with a 10-year time horizon. Estimates of costs, utilities, complication rates and probabilities of developing CKD were derived from the literature. The base case patient was assumed to be a 65-year-old patient with a <4 cm unilateral renal mass, a normal contralateral kidney and a normal pre-operative serum creatinine. Univariate and probabilistic sensitivity analyses were conducted to address the uncertainty associated with the study parameters. Results: OPN was the least costly strategy at $25941 USD and generated 7.161 QALYs over 10 years. LPN yielded 0.098 additional QALYs at an additional cost of $888 for an incremental cost-effectiveness ratio of $9057 per QALY, well below a commonly cited willingness-to-pay threshold of $50000 per QALY. LRN was more costly and yielded fewer QALYs than OPN and LPN. Sensitivity analyses demonstrated our model to be robust to changes to key parameters. Age had no effect on preferred strategy. Conclusions: Partial nephrectomy (PN) is the preferred treatment strategy for SRMs. In centers where LPN is not available, OPN remains considerably more cost-effective than LRN. Furthermore, our study demonstrates that there is no age at which PN is not preferred to LRN. Our study provides additional evidence to advocate PN for the management of all amenable SRMs.

641: Is Partial Nephrectomy for Small Renal Masses Associated with Improved Overall Survival Compared with Radical Nephrectomy?

2007 ◽  
Vol 177 (4S) ◽  
pp. 215-215 ◽  
Author(s):  
R. Houston Thompson ◽  
Stephen A. Boorjian ◽  
Christine M. Lohse ◽  
Bradley C. Leibovich ◽  
Michael L. Blute
Keyword(s):  
Overall Survival ◽  
Partial Nephrectomy ◽  
Radical Nephrectomy ◽  
Small Renal Masses ◽  
Renal Masses

scholarly journals Trends in the Management of Small Renal Masses: A Survey of Members of the Endourological Society

2017 ◽  
Vol 4 (3) ◽  
pp. 10-19 ◽  
Author(s):  
Anand Mohapatra ◽  
Aaron Potretzke ◽  
John Weaver ◽  
Barrett Anderson ◽  
Joel Vetter ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Partial Nephrectomy ◽  
Radical Nephrectomy ◽  
Treatment Modalities ◽  
Percutaneous Ablation ◽  
Robotic Partial Nephrectomy ◽  
Small Renal Masses ◽  
Renal Masses ◽  
Open Partial Nephrectomy ◽  
The Past

Treatment modalities for small renal masses (SRMs) include open or minimally invasive radical or partial nephrectomy, and laparoscopic or percutaneous ablations. Members of the Endourological Society were surveyed to evaluate how practitioner and clinical practice characteristics may be associated with the management of SRMs over time. The survey assessed characteristics of urologists (recency of residency and fellowship training, clinical practice type and location, and treatment modalities available) and their management of SRMs over the past year and over the course of the year 5 years prior. Of the 1495 surveys e-mailed, there were 129 respondents (8.6%). Comparing the past year to 5 years prior, there was increasing utilization of robotic partial nephrectomy (p < 0.001) and robotic radial nephrectomy (p = 0.031). In contrast, there was decreasing utilization of open partial nephrectomy (p < 0.001), open radical nephrectomy (p = 0.039), laparoscopic partial nephrectomy (p = 0.002), and laparoscopic radical nephrectomy (p = 0.041). Employment of laparoscopic ablation decreased (p = 0.001), but that of percutaneous ablation did not change significantly. For masses treated with image-guided therapy, there was increasing utilization of microwave ablation (p = 0.008) and decreasing usage of radiofrequency ablation (p = 0.002). Future studies should focus on the most effective treatment modalities based on provider, patient, and tumor characteristics.

V708: Partial Nephrectomy for Small Renal Masses: An Emerging Quality of Care Concern?

2006 ◽  
Vol 175 (4S) ◽  
pp. 229-229
Author(s):  
David C. Miller ◽  
John M. Hollingsworth ◽  
Khaled S. Hafez ◽  
Stephanie Daignault ◽  
Brent K. Hollenbeck
Keyword(s):  
Quality Of Care ◽  
Partial Nephrectomy ◽  
Small Renal Masses ◽  
Renal Masses

scholarly journals Intraoperative ultrasound in robot-assisted partial nephrectomy: State of the art

2018 ◽  
Vol 90 (3) ◽  
pp. 195-198 ◽  
Author(s):  
Giacomo Di Cosmo ◽  
Enrica Verzotti ◽  
Tommaso Silvestri ◽  
Andrea Lissiani ◽  
Roberto Knez ◽  
...  
Keyword(s):  
Partial Nephrectomy ◽  
State Of The Art ◽  
Short Review ◽  
Robot Assisted ◽  
Small Renal Masses ◽  
Renal Masses ◽  
Ischemia Time ◽  
Oncological Safety ◽  
Nephron Sparing ◽  
Operative Ultrasound

Introduction: Nephron-sparing surgery (NSS) is of one of the most studied fields in urology due to the balancing between renal function preservation and oncological safety of the procedure. Aim of this short review is to report the state of the art of intra-operative ultrasound as an operative tool to improve localization of small renal masses partially or completely endophytic during robotassisted partial nephrectomy (RAPN). Material and methods: We performed a literature review by electronic database on Pubmed about the use of intra-operative US in RAPN to evaluate the usefulness and the feasibility of this procedure. Results: Several studies analyzed the use of different US probes during RAPN. Among them some focused on using contrastenhanced ultra sonography (CEUS) for improving the dynamic evaluation of microvascular structure allowing the reduction of ischemia time (IT). We reported that nowaday the use of intraoperative US during RAPN could be helpful to improve the preservation of renal tissue without compromising oncological safety. Moreover, during RAPN there is no need for assistant to hand the US probe increasing surgeon autonomy. Conclusions: The use of a robotic ultrasound probe during partial nephrectomy allows the surgeon to optimize tumor identification with maximal autonomy, and to benefit from the precision and articulation of the robotic instrument during this key step of the partial nephrectomy procedure. Moreover US could be useful to reduce ischemia time (IT). The advantages of nephron-sparing surgery over radical nephrectomy is well established with a pool of data providing strong evidence of oncological and survival equivalency. With the progressive growth of robot-assisted partial nephrectomy (RAPN) techniques, the use of several tools has been progressively developed to help the surgeon in the identification of masses and its vascular net. In this short review we tried to analyze the current use of intra-operative ultrasound as an operative tool to improve localization of small renal masses partially or completely endophytic during RAPN.

Sign in / Sign up

Export Citation Format

Share Document