Renal nephrometry score is associated with urine leak after partial nephrectomy

Background: Partial nephrectomy became more preferred option in the treatment of localized small renal tumours due to recent advances in imaging modalities and surgical techniques. Renal scoring systems are known to compliment urologist in aiding surgical decision process on extent of surgery in small localized renal tumours. There are few scoring systems described in the literature with their own limitations. Methods: This is a retrospective study of patients with localized renal cell tumours who underwent nephrectomy at Nizam Institute of Medical Sciences (NIMS), Hyderabad fromJanuary 2017 to January 2019. Patients with advanced renal cell cancer disease at presentation were excluded. Total RENAL nephrometry Score (RNS), its individual component scores and complexity category were calculated based on CT report. The study cases were categorized into Group A (Partial Nephrectomy) and as Group B (Radical Nephrectomy). Mean and standard deviation value of the RENAL nephrometry scores and its component scores were calculated for each group. Statistical signicance was calculated using unpaired T-test, using SPSS statistics 21.0 software. Results: The mean age for all patients included in this study is 52.1 years. Out of 80 patients, 32 patients had partial nephrectomy (Group A) and 48 patients had radical nephrectomy (Group B). Based on RENAL nephrometry score complexity, Group A and Group B were further categorized into low, intermediate and high complexity score categories. The total RENAL score, individual component scores and RENAL score complexity were found to be signicantly different between the two group in addition to the tumor size. No statistical signicance was found between the two groups for age and type of tumour on histopathology (benign or malignant). Conclusion: We conclude that preoperative RENAL nephrometry scoring is a useful aid to surgeons to classify the renal tumour complexity before deciding on effective surgical strategy for better patient outcomes

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Bleeding during laparoscopic partial nephrectomy: Can a hemostatic matrix help to improve hemostasis?

Archivio Italiano di Urologia e Andrologia ◽

10.4081/aiua.2016.3.228 ◽

2016 ◽

Vol 88 (3) ◽

pp. 228 ◽

Cited By ~ 2

Author(s):

Faruk Ozgor ◽

Abdulmuttalip Simsek ◽

Ozgu Aydogdu ◽

Onur Kucuktopcu ◽

Omer Sarilar ◽

...

Keyword(s):

Partial Nephrectomy ◽

Tumor Size ◽

Operation Time ◽

Demographic Characteristics ◽

Ischemia Time ◽

Nephrometry Score ◽

The Mean ◽

Group 1

Objectives: To evaluate the possible role of an hemostatic matrix on hemostasis, perioperative outcomes and complications in patients who underwent laparoscopic partial nephrectomy (LPN). Materials and methods: Patients charts were analyzed retrospectively and their demographic characteristics, operative parameters and follow-up results were recorded. Patients were divided into two groups, according to those who used an hemostatic matrix as Group 1 (n = 41) and those who did not used as Group 2 (n = 44). Demographic characteristics of patients, tumor features, operation time, clamping of the renal vessels, ischemia time, suturing of the collecting system, perioperative hemorrhage and complications were evaluated. Histopathological results, surgical margin status, creatinine level and recurrence at the 3rd month of follow up were analyzed. Statistical analyses were performed with SPSS 17.0 and significance was set at p value of < 0.05. Results: The mean RENAL nephrometry score was 5.9 ± 2.0 and the mean tumor size was 35 ± 12 mm. All patients had a single tumor and 44 of them had a tumor in the right kidney. The renal artery was clamped in 79 cases and the mean ischemia time was 20.1 ± 7 minutes. The mean tumor size and the mean RENAL nephrometry score was statistically higher in Group 1 (p: 0.016 and p < 0.001, respectively). Pelvicaliceal repair was more common in Group 1 due to deeper extension of tumors in this group (p: 0.038). In Group 1, less hemorrhage and blood transfusion requirement, with shorter ischemia and operation time was detected. Conclusion: The outcomes of the recent study showed that adjunctive use of an hemostatic matrix improves hemostasis and decreases hemorrhagic complications during LPN. Further prospective studies are required to assess the potential role of an hemostatic matrix in LPN.

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Association between R.E.N.A.L nephrometry score and perioperative outcomes following open partial nephrectomy under cold ischemia

Canadian Urological Association Journal ◽

10.5489/cuaj.1372 ◽

2014 ◽

Vol 8 (3-4) ◽

pp. 137

Author(s):

Dong Soo Park ◽

Jin Ho Hwang ◽

Moon Hyung Kang ◽

Jong Jin Oh

Keyword(s):

Blood Loss ◽

Partial Nephrectomy ◽

Perioperative Outcomes ◽

Renal Neoplasm ◽

Cold Ischemia ◽

Ischemic Time ◽

Open Partial Nephrectomy ◽

Cold Ischemic Time ◽

Nephrometry Score ◽

Estimated Blood Loss

Introduction: We investigate the clinical significance of the R.E.N.A.L. nephrometry score for renal neoplasm following open partial nephrectomy (PN) under cold ischemia.Methods: A retrospective analysis was conducted using clinical data of 98 consecutive patients with clear cell renal cell carcinoma who underwent open PN by a single surgeon from December 2000 to September 2012. Tumour complexity was stratified into 3 categories: low (4-6), moderate (7-9) and high (10-12) complexity. Perioperative outcomes, such as complications, cold ischemic time, estimated blood loss and renal function, were analyzed according to the complexity by NS. Complications were stratified using the Clavien-Dindo classification system.Results: Tumour complexity according to nephrometry score was assessed as low in 16 (16.3%), moderate in 48 (49.0%) and high in 34 (34.7%). The median cold ischemic time did not differ significantly among the 3 groups (36.0 minutes in low-, 40 minutes in moderate- and 43 minutes in the high-complexity group, p = 0.421). Total complications did not differ significantly (2 (2.0%) in low, 4 (4.1%) in moderate and 4 (4.1%) in high, p = 0.984). Each Grade 3 complication occurred in the moderate (urine leakage) and high groups (lymphocele). Postoperative renal functional outcomes were similar among the groups (p = 0.729). Only mean estimated blood loss was significantly different with nephrometry score (p = 0.049).Conclusions: The nephrometry score, as used in an open PN series under cold ischemia, was not significantly associated with perioperative outcomes (i.e., ischemia time, complications, renal functional preservation).

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