Options for assessing renal function after organ-preserving operations in patients with renal cell carcinoma

Introduction. Despite the improvement of various methods of surgical and ablative methods of treating kidney cancer, the question remains about the functional state of the kidney after surgical treatment. Along with the achievement of oncological results, the preservation of renal function is the main task in the treatment of tumorous diseases of the kidneys. Aim. To evaluate the functional results of organ-preserving operations with a preventive suture with preserved blood flow, as well as in patients who underwent a resection of the kidney with compression of the renal pedicle, using nephroscintigraphy. Material and Methods. The study included 175 patients in stages pT1a-T2bN0M0, which are divided into 2 groups. Group 1 – 150 patients who underwent organ-preserving options with the use of preventive hemostatic sutures, allowing operations to be performed without clamping the kidney leg. 25 patients underwent a resection of the kidney with compression of the renal pedicle. To assess renal function, patients underwent dynamic nephroscintigraphy. In the first group, the tumor was located in the central segment in 64 patients, in the upper segment in 45 patients, in the lower segment in 41 patients. Stage T1a was established in 74 patients, stage T1b in 53 patients, stage T2a in 4 patients. In 19 patients diagnosed with cystic T1a cancers. In the second group in the central segment – in 10 patients, in the upper segment in 7 patients and in 8 patients in the lower. According to the stages, patients were divided as follows – T1a – 16, T1b – 8, T2a – 1. Results. Organ-preserving operations were performed for all patients. In the first group, in no case did the renal pedicle be pinched. The average time of thermal ischemia in the second group was 13 ± 2 min. The perfusion and renal index for the operated kidney in both groups was comparable, and amounted to 54.13 ± 2% and 53.24 ± 4%. However, after surgical treatment, the indicators were significantly different. In the first group, the perfusion index was 46.82 ± 2.39% against 35 ± 1.52% in the second, the renal index in the first group was 46.82 ± 2.39%, against 39 ± 0.88% in the second. Conclusion. Thus, even short-term thermal ischemia leads to significant impairment of renal function. Preventive suture allows you to remove a tumor from any part of the kidney, while maintaining blood flow, and allows you to protect the renal parenchyma from ischemic damage.

Safety and efficacy of inferoposterior access approach to the renal pedicle during transperitoneal laparoscopic radical nephrectomy: A retrospective comparative analysis at a single institution

Purpose To assess the safety and efficacy of transperitoneal laparoscopic radical nephrectomy using an inferoposterior approach to the renal pedicle. Materials and methods A retrospective review of 89 patients who underwent transperitoneal laparoscopic radical nephrectomy by a single surgeon between June 2014 and December 2019 at a single urological unit was carried out. Access to the renal pedicle was via the inferoposterior approach in 48 cases (study group) and 41 were approached via the conventional anterior approach (control group). Patient demographics, intra-operative anatomical findings, and procedural details including operative time on renal pedicles and post-operative outcomes were recorded. Post-operative complications were recorded and classified according to the Clavien-Dindo classification. A comparative analysis between the two groups was performed using Chi-square test and t-test. Results The inferoposterior approach group had a shorter operative time (132.85±26.65 min vs 153.46±39.94 min; p<0.01), which could be attributed to the shorter time spent operating on the renal vasculature (46.31±6.16 min vs 64.46±7.64 min; p<0.01). Lower average blood loss was also observed in the inferoposterior approach group (42 ml vs 62 ml; p<0.05). No significant difference was identified concerning the mean patient age, body mass index, tumor size, number of renal vessels identified, and post-operative length of stay between the two groups. None of the patients required conversion to open. Conclusion Inferoposterior approach to access the renal pedicle during transperitoneal laparoscopic radical nephrectomy is a safe and effective technique, which shortens the operative time when compared to the conventional anterior approach. Level of evidence: Level 3b.

Evaluation of the Effects of Silver Nitrate Renal Pelvic Instillation and Retroperitoneoscopic Renal Pedicle Lymphatic Disconnection for Chyluria

Introduction: In this study, the efficacy, advantages, and disadvantages of transurethral cystoscopic silver nitrate renal pelvic instillation and retroperitoneoscopic renal pedicle lymphatic disconnection for chyluria were compared to provide a clinical reference. Methods: Forty patients with chyluria who were admitted to our hospital between June 2007 and June 2017 were selected as the research subjects and divided into two groups. The patients in group A (n=25) were treated with transurethral cystoscopic silver nitrate renal pelvic instillation regimen, while those in group B (n=15) were treated by retroperitoneoscopic renal pedicle lymphatic disconnection. Operative time, intraoperative blood loss volume, length of postoperative hospital stay, cure rate, complication rate and recurrence rate were compared between the two groups. Results: All the 40 patients were successfully treated. Group B had a higher cure rate, lower complication rate and lower recurrence rate than in group A, the differences were statistically significant (P < 0.05). But group A had a shorter length of hospital stay and less surgical trauma, the differences were statistically significant (P < 0.05). Conclusion: Retroperitoneoscopic renal pedicle lymphatic disconnection for chyluria can be used as one of the first choices of treatment for chyluria. Although the recurrence rate with transurethral cystoscopic silver nitrate renal pelvic instillation is high, the treatment can be administered again when the disease recurs. At the same time, it is less invasive to the patients and they are more receptive.

Renal artery embolisation immediately prior to emergency trauma nephrectomy

The aim of emergency nephrectomy in cases of blunt renal trauma is to control bleeding and so should not be delayed. We present a case of grade V blunt renal trauma where renal artery emoblisation (RAE) was used in the operating theatre immediately prior to trauma nephrectomy in order to control arterial haemorrhage. In this case, prior utilisation of RAE allowed the urologist to perform a standard approach to the renal pedicle by opening the retroperitoneal space. This is more routinely practiced and carries less risk of vascular mesenteric injury compared with the standard approach in trauma. Intra-operatively, there was minimal bleeding and the intra-vascular coils were easily ligated. Post operatively the patient avoids the sequelae of an ischaemic kidney associated with delayed interval nephrectomy.

Evaluation of protective effects of melatonin on free radical metabolism in rat kidney during ischemia-reperfusion

The purpose of this research was to investigate the possible protective effect of melatonin, as a potent antioxidant on I/R-induced renal injury in rats. Methods. We used 28 female Wistar albino rats weight 200-250g. The rats were randomly divided into 4 groups. Control Group (C): They were fed with only standard rat diet and tap water without drug injections or ischemia-reperfusion. Melatonin Group (M): 25 mg/kg melatonin was administered i.p 30 min. Ischemia/Reperfusion Group (I/R): Rats were subjected to 45 min of renal pedicle occlusion followed by 24 hours reperfusion. Melatonin+ischemia/reperfusion Group (M+I/R): Melatonin (25 mg/kg) was administered 30 min prior to ischemia and immediately before the reperfusion period. Rats were subjected to 45 min of renal pedicle occlusion followed by 24 hours reperfusion. Results. While MDA levels increased in the I/R group, SOD and GST activities were seen to be significantly increased. Although the increase of the SOD activity was observed in the M+I/R group, no meaningful difference was found. MDA levels were significantly decreased in M+I/R group compared to the control group, CAT and GST activities were significantly increased. Conclusions. Our results show that the treatment with M may prevent kidney damage due to ischemia result in increasing oxidant stress peroxidation damages further. Melatonin or its metabolites are capable of neutralizing free radicals and non-radical oxygen-based reactants. This study suggests that melatonin may be an effective antioxidant agent.