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Jihad H Kaouk - One of the best experts on this subject based on the ideXlab platform.
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nephron sparing surgery for tumors in a Solitary Kidney
Current Opinion in Urology, 2014Co-Authors: Homayoun Zargar, Riccardo Autorino, Jihad H KaoukAbstract:Purpose of reviewPresence of a tumor in a Solitary Kidney is an absolute indication for performing nephron-sparing surgery (NSS). In the past two decades, new modalities for treatment of small renal mass have emerged but despite their evolution and promising results, partial nephrectomy remains the
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robotic versus laparoscopic partial nephrectomy for tumor in a Solitary Kidney a single institution comparative analysis
International Journal of Urology, 2013Co-Authors: Georgespascal Haber, Riccardo Autorino, Shahab Hillyer, Kamol Panumatrassamee, Humberto Laydner, Ali Khalifeh, Ahmad Kassab, Robert J Stein, Jihad H KaoukAbstract:Objectives To compare the outcomes of robot-assisted laparoscopic partial nephrectomy and laparoscopic partial nephrectomy for renal tumor in patients with a Solitary Kidney. Methods We retrospectively reviewed data of patients with Solitary Kidney who underwent laparoscopic (n = 52) and robot-assisted (n = 15) partial nephrectomy for renal tumor at Cleveland Clinic, Cleveland, Ohio, USA, between June 2000 and April 2012. Patient demographic data, perioperative parameters and follow-up data were compared. Results The two groups were similar in terms of patients and tumor characteristics, including preoperative renal function and etiology of Solitary Kidney. The median operative time (225 vs 171 min, P = 0.02), warm ischemia time (19 vs 15 min, P = 0.04) and hospital stay (4 vs 3 days, P = 0.03) were significantly shorter in the robotic group. No significant differences were found in terms of estimated blood loss, transfusion, complications, pathological results and margin status. The median percentage change of renal function was not significantly different between two groups. Long-term hemodialysis was required for three patients in the laparoscopic group (6%) and none of the patients in the robotic group. Median follow up was 15.6 and 5.9 months in the laparoscopic and robotic group, respectively. Conclusions Robot-assisted partial nephrectomy represents a safe and effective minimally-invasive treatment option for renal masses in patients with a Solitary Kidney. Early comparative outcomes suggest that it offers a significant benefit over the laparoscopic approach in terms of operative time, warm ischemia time and hospital stay. Further studies with a longer follow up are required to confirm the likelihood of better long-term functional and oncological outcomes.
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cryoablation versus minimally invasive partial nephrectomy for small renal masses in the Solitary Kidney impact of approach on functional outcomes
The Journal of Urology, 2013Co-Authors: Jihad H Kaouk, Riccardo Autorino, Kamol Panumatrassamee, Humberto Laydner, Andrew T Lenis, Wahib Isac, Jeanalexandre Long, R Eyraud, Ahmad KassabAbstract:Purpose: We evaluated the change in renal function after renal cryoablation and partial nephrectomy based on tumor complexity according to the R.E.N.A.L. nephrometry score.Materials and Methods: We retrospectively reviewed the data of patients who had a renal tumor in a Solitary Kidney, and underwent renal cryoablation and partial nephrectomy between December 2000 and January 2012. Renal tumor complexity was categorized into 3 groups by R.E.N.A.L. nephrometry score as low (4 to 6), intermediate (7 to 9) and high (10 to 12). All baseline demographic data, perioperative parameters and followup data including renal function were collected. Comparisons were made among similar tumor complexities.Results: In the renal cryoablation and partial nephrectomy groups 29 patients (43 tumors) and 33 patients were identified, respectively. In all renal tumor complexities, renal cryoablation provided a better perioperative outcome in terms of median operative time, estimated blood loss, transfusion, hospital stay and com...
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fenoldopam and renal function after partial nephrectomy in a Solitary Kidney a randomized blinded trial
Urology, 2013Co-Authors: Jerome F Ohara, Ramatia Mahboobi, Steven M Novak, Kristina Kaple, A. Bonilla, Steven C. Campbell, Amr Fergany, Jihad H Kaouk, Edward J Mascha, Inderbir S. GillAbstract:Objective To test the hypothesis that fenoldopam administration ameliorates ischemic injury, preserving the glomerular filtration rate and serum creatinine postoperatively after partial nephrectomy in patients with a Solitary Kidney. Materials and Methods Fenoldopam is a short-acting dopamine-1 receptor agonist that might provide renal protection during ischemic stress. A total of 90 patients with a Solitary functioning Kidney who were undergoing partial nephrectomy were randomized to fenoldopam or placebo in a double-blind protocol. The patients assigned to fenoldopam received an infusion rate of 0.1 μg/kg/min for 24 hours. The effect of fenoldopam on renal function was assessed by comparing the groups on the change in glomerular filtration rate from baseline to the third postoperative day (primary outcome) and on the change in serum creatinine over time (secondary outcome). Results Of the 90 enrolled patients, 77 provided analyzable data (43 in fenoldopam and 44 in placebo group). Fenoldopam (vs placebo) did not reduce the mean percentage of change in the glomerular filtration rate from baseline to the third postoperative day ( P = .15), with an estimated ratio of means of 0.89 (95% confidence interval 0.69-1.09) for fenoldopam vs placebo. The postoperative serum creatinine in the 2 groups changed at comparable rates from postoperative day 1 to 4 (group-by-time interaction, P = .72) after adjusting for baseline creatinine, with no difference in the mean serum creatinine over time ( P = .78). Conclusion Fenoldopam administration did not preserve renal function in the clinical setting of renal ischemia during Solitary partial nephrectomy, as evidenced by changes in the glomerular filtration rate or serum creatinine.
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robotic partial nephrectomy for Solitary Kidney a multi institutional analysis
Urology, 2013Co-Authors: Shahab Hillyer, Sam B Bhayani, Mohamad E Allaf, Craig G Rogers, Michael D Stifelman, Youssef S Tanagho, Jeffrey K Mullins, Yichun Chiu, Bartosz F Kaczmarek, Jihad H KaoukAbstract:Objective To evaluate the outcomes of robotic partial nephrectomy (RPN) for Solitary Kidney in a large multicenter series. Materials and Methods Medical records of 886 consecutive patients who underwent RPN at 5 academic institutions from May 2007 to May 2012 were retrospectively analyzed. Data were prospectively collected in an Investigational Review Board-approved protocol. Experienced robotic surgeons performed all operations. Patient demographics, functional, perioperative, and early oncologic outcomes were analyzed. Results A total of 26 patients with a Solitary Kidney were identified and included in the analysis; of these, 16 (62%) had Solitary Kidneys secondary to a previous malignancy. Perioperative outcomes included a median warm ischemia time of 17 minutes (interquartile range, 12, 28 minutes). Only 2 intraoperative complications occurred. One was a renal vein injury and one an aortic vessel tear, and both patients required intraoperative blood transfusions. No conversions to laparoscopy or open surgery occurred. There were 3 postoperative complications (11.5%). Median follow-up was 6 months (interquartile range, 5, 9.7 months). Postoperative renal function did not change significantly as measure by estimated glomerular filtration rate (−15.8%; P = .13). None of the patients required dialysis. Positive margins occurred in 1 patient, with 73% of patients having a renal cell carcinoma. Conclusion We report a multi-institutional series of RPN in patients with Solitary Kidney presenting with small renal masses. Our findings suggest that RPN represents a feasible treatment option in this specific population by offering reliable preservation of renal function, low surgical morbidity, and early oncologic safety in the hands of experienced robotic surgeons.
Inderbir S. Gill - One of the best experts on this subject based on the ideXlab platform.
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fenoldopam and renal function after partial nephrectomy in a Solitary Kidney a randomized blinded trial
Urology, 2013Co-Authors: Jerome F Ohara, Ramatia Mahboobi, Steven M Novak, Kristina Kaple, A. Bonilla, Steven C. Campbell, Amr Fergany, Jihad H Kaouk, Edward J Mascha, Inderbir S. GillAbstract:Objective To test the hypothesis that fenoldopam administration ameliorates ischemic injury, preserving the glomerular filtration rate and serum creatinine postoperatively after partial nephrectomy in patients with a Solitary Kidney. Materials and Methods Fenoldopam is a short-acting dopamine-1 receptor agonist that might provide renal protection during ischemic stress. A total of 90 patients with a Solitary functioning Kidney who were undergoing partial nephrectomy were randomized to fenoldopam or placebo in a double-blind protocol. The patients assigned to fenoldopam received an infusion rate of 0.1 μg/kg/min for 24 hours. The effect of fenoldopam on renal function was assessed by comparing the groups on the change in glomerular filtration rate from baseline to the third postoperative day (primary outcome) and on the change in serum creatinine over time (secondary outcome). Results Of the 90 enrolled patients, 77 provided analyzable data (43 in fenoldopam and 44 in placebo group). Fenoldopam (vs placebo) did not reduce the mean percentage of change in the glomerular filtration rate from baseline to the third postoperative day ( P = .15), with an estimated ratio of means of 0.89 (95% confidence interval 0.69-1.09) for fenoldopam vs placebo. The postoperative serum creatinine in the 2 groups changed at comparable rates from postoperative day 1 to 4 (group-by-time interaction, P = .72) after adjusting for baseline creatinine, with no difference in the mean serum creatinine over time ( P = .78). Conclusion Fenoldopam administration did not preserve renal function in the clinical setting of renal ischemia during Solitary partial nephrectomy, as evidenced by changes in the glomerular filtration rate or serum creatinine.
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tumour in Solitary Kidney laparoscopic partial nephrectomy vs laparoscopic cryoablation
BJUI, 2012Co-Authors: Georgespascal Haber, Michael C Lee, Sebastien Crouzet, Kazumi Kamoi, Inderbir S. GillAbstract:Study Type – Therapy (cohort) Level of Evidence 2b What’s known on the subject? and What does the study add? Tumour in a Solitary functioning Kidney represents an absolute indication for nephron-sparing surgery whenever technically feasible. We report the longest follow-up data comparing laparoscopic partial nephrectomy and laparoscopic cryoablation in patients with Solitary Kidney with oncological follow-up to five years. OBJECTIVES • We compare perioperative, functional and intermediate-term oncological outcomes of laparoscopic partial nephrectomy (LPN) vs laparoscopic cryoablation (LCA) for small renal tumour in patients with a Solitary Kidney. • A treatment algorithm is also proposed. PATIENT AND METHODS • Over a 10-year period (02/1998-09/2008), 78 patients with a small tumour in a functionally Solitary Kidney underwent LPN (n= 48) or LCA (n= 30). • Baseline, perioperative, and follow-up data were collected prospectively and analyzed retrospectively. RESULTS • Demographic data were similar between the LPN and LCA groups. Tumours were somewhat larger (3.2 vs 2.6 cm) in the LPN group. LPN was associated with greater blood loss (391 vs 162 mL; P= 0.003), and trended towards more post-operative complications (22.9% vs 6.7%; P= 0.07). • By 3 months post-operative, eGFR decreased by 14.5% and 7.3% after LPN and LCA, respectively (P= 0.02). Post-operative temporary dialysis was required after 3 LPN (6.2% vs 0%, P= 0.16). • Median follow-up time for LPN and LCA was 42.7 and 60.2 months, respectively. • Local recurrence was detected in 4 (13.3%) LCA patients only (P= 0.02). • Overall survival was comparable between LPN and LCA at 3 and 5 years, respectively (P= 0.74). The LPN group had superior cancer-specific and recurrence-free survival at 3 and 5 years compared to the LCA group (P < 0.05, for all comparisons). CONCLUSIONS • Given adequate technical expertise, both LPN and LCA are viable nephron-sparing options for patients with tumour in a Solitary Kidney. • Although LCA is technically easier and has superior functional outcomes, oncologic outcomes are superior after LPN.
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comparison of warm ischemia versus no ischemia during partial nephrectomy on a Solitary Kidney
European Urology, 2010Co-Authors: Houston R Thompson, Steven C. Campbell, Amr Fergany, Inderbir S. Gill, Igor Frank, Brian R Lane, Christine M Lohse, Bradley C Leibovich, Michael L BluteAbstract:Abstract Background The safe duration of warm ischemia during partial nephrectomy (PN) remains controversial. Objective To compare the short- and long-term renal effects of warm ischemia versus no ischemia in patients with a Solitary Kidney. Design, setting, and participants Using the Cleveland Clinic and Mayo Clinic databases, we identified 458 patients who underwent open ( n =411) or laparoscopic ( n =47) PN for a renal mass in a Solitary Kidney between 1990 and 2008. Patients treated with cold ischemia were excluded. Measurements Associations of ischemia type (none vs warm) with short- and long-term renal function were evaluated using logistic or Cox regression models. Results and limitations No ischemia was used in 96 patients (21%), while 362 patients (79%) had a median of 21min (range: 4–55) of warm ischemia. Patients treated with warm ischemia had a significantly higher preoperative glomerular filtration rate (GFR; median: 61ml/min per 1.73m 2 vs 54ml/min per 1.73m 2 ; p p p =0.044) and a GFR 2 in the postoperative period (OR: 4.2; p =0.007) compared with patients who did not have hilar clamping. Among the 297 patients with a preoperative GFR ≥30ml/min per 1.73m 2 , patients with warm ischemia were significantly more likely to develop new-onset stage IV chronic Kidney disease (hazard ratio: 2.3; p =0.028) during a mean follow-up of 3.3 yr. Similar results were obtained adjusting for preoperative GFR, tumor size, and type of PN in a multivariable analysis. Limitations include surgeon selection bias when determining type of ischemia. Conclusions Warm ischemia during PN is associated with adverse renal consequences. Although selection bias is present, PN without ischemia should be used when technically feasible in patients with a Solitary Kidney.
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laparoscopic partial nephrectomy in Solitary Kidney
The Journal of Urology, 2006Co-Authors: Inderbir S. Gill, Jihad H Kaouk, Jose R Colombo, Alireza Moinzadeh, Antonio Finelli, Osamu Ukimura, Kay Tucker, Mihir M DesaiAbstract:Purpose: We report our experience with LPN for tumor in a Solitary Kidney.Materials and Methods: Of 430 patients undergoing LPN since February 1999 at our institution 22 (5%) underwent LPN for tumor in a Solitary Kidney, as performed by a single surgeon. The laparoscopic technique that we used duplicated open principles, including hilar clamping, cold cut tumor excision and sutured renal reconstruction.Results: Mean tumor size was 3.6 cm (range 1.4 to 8.3, median 3 cm), median blood loss was 200 cc (range 50 to 500), warm ischemia time was 29 minutes (range 14 to 55), total operative time was 3.3 hours (range 2.2 to 4.5) and hospital stay was 2.8 days (range 1.3 to 12). Two cases (9%) were electively converted to open surgery. Pathological findings confirmed renal cell carcinoma in 16 patients (73%) with negative surgical margins in all those with LPN. Major complications occurred in 3 patients (15%) and minor complications developed in 7 (32%). Median preoperative and postoperative serum creatinine (1.2 ...
Amr Fergany - One of the best experts on this subject based on the ideXlab platform.
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five to 10 year followup of open partial nephrectomy in a Solitary Kidney
The Journal of Urology, 2013Co-Authors: Christina B Ching, Steven C. Campbell, Brian R Lane, Amr FerganyAbstract:Purpose: Followup is limited in patients with a Solitary Kidney who undergo partial nephrectomy. We evaluated overall, cancer specific and recurrence-free survival, and renal function in patients 5 years or greater after open partial nephrectomy.Materials and Methods: We retrospectively reviewed the Cleveland Clinic Kidney cancer database, including only patients with a Solitary Kidney treated with open partial nephrectomy 5 or more years ago (from 1980 to June 2006) who had 6 months or more of followup. Survival and recurrence analyses were calculated using a Cox proportional hazards model. Results are shown as Kaplan-Meier survival curves. Linear regression analysis was done to assess postoperative renal function.Results: A total of 282 patients fit our study inclusion criteria (mean followup 175 months), of whom 233 underwent open partial nephrectomy 10 or more years ago. Actual overall survival was 78.5% and 59.5% at 5 and 10 years, respectively. The average estimated glomerular filtration rate at 5 y...
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fenoldopam and renal function after partial nephrectomy in a Solitary Kidney a randomized blinded trial
Urology, 2013Co-Authors: Jerome F Ohara, Ramatia Mahboobi, Steven M Novak, Kristina Kaple, A. Bonilla, Steven C. Campbell, Amr Fergany, Jihad H Kaouk, Edward J Mascha, Inderbir S. GillAbstract:Objective To test the hypothesis that fenoldopam administration ameliorates ischemic injury, preserving the glomerular filtration rate and serum creatinine postoperatively after partial nephrectomy in patients with a Solitary Kidney. Materials and Methods Fenoldopam is a short-acting dopamine-1 receptor agonist that might provide renal protection during ischemic stress. A total of 90 patients with a Solitary functioning Kidney who were undergoing partial nephrectomy were randomized to fenoldopam or placebo in a double-blind protocol. The patients assigned to fenoldopam received an infusion rate of 0.1 μg/kg/min for 24 hours. The effect of fenoldopam on renal function was assessed by comparing the groups on the change in glomerular filtration rate from baseline to the third postoperative day (primary outcome) and on the change in serum creatinine over time (secondary outcome). Results Of the 90 enrolled patients, 77 provided analyzable data (43 in fenoldopam and 44 in placebo group). Fenoldopam (vs placebo) did not reduce the mean percentage of change in the glomerular filtration rate from baseline to the third postoperative day ( P = .15), with an estimated ratio of means of 0.89 (95% confidence interval 0.69-1.09) for fenoldopam vs placebo. The postoperative serum creatinine in the 2 groups changed at comparable rates from postoperative day 1 to 4 (group-by-time interaction, P = .72) after adjusting for baseline creatinine, with no difference in the mean serum creatinine over time ( P = .78). Conclusion Fenoldopam administration did not preserve renal function in the clinical setting of renal ischemia during Solitary partial nephrectomy, as evidenced by changes in the glomerular filtration rate or serum creatinine.
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comparison of warm ischemia versus no ischemia during partial nephrectomy on a Solitary Kidney
European Urology, 2010Co-Authors: Houston R Thompson, Steven C. Campbell, Amr Fergany, Inderbir S. Gill, Igor Frank, Brian R Lane, Christine M Lohse, Bradley C Leibovich, Michael L BluteAbstract:Abstract Background The safe duration of warm ischemia during partial nephrectomy (PN) remains controversial. Objective To compare the short- and long-term renal effects of warm ischemia versus no ischemia in patients with a Solitary Kidney. Design, setting, and participants Using the Cleveland Clinic and Mayo Clinic databases, we identified 458 patients who underwent open ( n =411) or laparoscopic ( n =47) PN for a renal mass in a Solitary Kidney between 1990 and 2008. Patients treated with cold ischemia were excluded. Measurements Associations of ischemia type (none vs warm) with short- and long-term renal function were evaluated using logistic or Cox regression models. Results and limitations No ischemia was used in 96 patients (21%), while 362 patients (79%) had a median of 21min (range: 4–55) of warm ischemia. Patients treated with warm ischemia had a significantly higher preoperative glomerular filtration rate (GFR; median: 61ml/min per 1.73m 2 vs 54ml/min per 1.73m 2 ; p p p =0.044) and a GFR 2 in the postoperative period (OR: 4.2; p =0.007) compared with patients who did not have hilar clamping. Among the 297 patients with a preoperative GFR ≥30ml/min per 1.73m 2 , patients with warm ischemia were significantly more likely to develop new-onset stage IV chronic Kidney disease (hazard ratio: 2.3; p =0.028) during a mean follow-up of 3.3 yr. Similar results were obtained adjusting for preoperative GFR, tumor size, and type of PN in a multivariable analysis. Limitations include surgeon selection bias when determining type of ischemia. Conclusions Warm ischemia during PN is associated with adverse renal consequences. Although selection bias is present, PN without ischemia should be used when technically feasible in patients with a Solitary Kidney.
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open partial nephrectomy for tumor in a Solitary Kidney experience with 400 cases
The Journal of Urology, 2006Co-Authors: Amr Fergany, Ismail R Saad, Lynn L Woo, Andrew C NovickAbstract:Purpose: We present a series of 400 patients with tumor in a Solitary Kidney who underwent open surgical partial nephrectomy performed by a single surgeon (ACN) with a primary focus on postoperative long-term Kidney function.Materials and Methods: A total of 400 patients with sporadic nonfamilial Kidney tumors in a Solitary Kidney underwent open partial nephrectomy between 1980 and 2002. In 323 patients (81%) the contralateral Kidney had been surgically removed, while the remaining 77 (19%) had a congenital Solitary Kidney. Renal insufficiency was present preoperatively in 184 patients (46%). Adverse risk factors for partial nephrectomy were present in a large percent of patients. Intraoperative and postoperative parameters were evaluated at a mean followup of 44 months.Results: In the overall series 5 and 10-year cancer specific survival was 89% and 82%, respectively. Surgical complications occurred in 52 patients (13%), most commonly urinary leakage. Early postoperative renal function was achieved in 39...
Georgespascal Haber - One of the best experts on this subject based on the ideXlab platform.
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the effect of partial nephrectomy on blood pressure in patients with Solitary Kidney
World Journal of Urology, 2021Co-Authors: Nikhil Gupta, Steven C. Campbell, Vishnu Ganesan, Tian Min Gao, Joseph Zabell, Georgespascal HaberAbstract:To determine the effect of partial nephrectomy (PN) in the Solitary Kidney on systolic and diastolic blood pressures (SBP and DBP, respectively), and use of antihypertensive medications. We performed a retrospective cohort study of Solitary Kidney patients who underwent PN for Kidney cancer from 1999–2015. Primary outcomes evaluated were blood pressure (BP) and antihypertensive medication changes from baseline up to 5 years postoperatively. Using a multivariable mixed-effects model to account for repeated measurements, we evaluated the effect of PN on the outcome measurements while controlling for baseline patient, pathologic, and perioperative characteristics. 292 patients who underwent PN on Solitary Kidneys met inclusion criteria (median [range] age, 63 [24–84] years; 179 men [61%]). SBP decreased immediately postoperatively (− 1.7 mmHg [− 2.6, − 0.7], p < 0.001), and further decreased by 0.04 mmHg per year (p = 0.01) postoperatively, for a total change of − 1.9 [− 3.9, 0.2] mmHg at 5 years (p = 0.01). DBP decreased immediately postoperatively (− 2.2 mmHg [− 2.7, − 1.7], p < 0.001), and then rebounded by 0.37 mmHg per year (p = 0.003) postoperatively, for a total change of − 0.4 [− 1.5, 0.7] mmHg at 5 years (p = 0.003). Antihypertensive medication use increased at 5 years (0.35 more medications per patient, p < 0.001). Our results suggest a minimal change in BP after PN, although patients increased antihypertensive medication use. This data suggests damage to renal parenchyma or hilar nerves during PN did not significantly impact BP regulation in our cohort.
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robotic versus laparoscopic partial nephrectomy for tumor in a Solitary Kidney a single institution comparative analysis
International Journal of Urology, 2013Co-Authors: Georgespascal Haber, Riccardo Autorino, Shahab Hillyer, Kamol Panumatrassamee, Humberto Laydner, Ali Khalifeh, Ahmad Kassab, Robert J Stein, Jihad H KaoukAbstract:Objectives To compare the outcomes of robot-assisted laparoscopic partial nephrectomy and laparoscopic partial nephrectomy for renal tumor in patients with a Solitary Kidney. Methods We retrospectively reviewed data of patients with Solitary Kidney who underwent laparoscopic (n = 52) and robot-assisted (n = 15) partial nephrectomy for renal tumor at Cleveland Clinic, Cleveland, Ohio, USA, between June 2000 and April 2012. Patient demographic data, perioperative parameters and follow-up data were compared. Results The two groups were similar in terms of patients and tumor characteristics, including preoperative renal function and etiology of Solitary Kidney. The median operative time (225 vs 171 min, P = 0.02), warm ischemia time (19 vs 15 min, P = 0.04) and hospital stay (4 vs 3 days, P = 0.03) were significantly shorter in the robotic group. No significant differences were found in terms of estimated blood loss, transfusion, complications, pathological results and margin status. The median percentage change of renal function was not significantly different between two groups. Long-term hemodialysis was required for three patients in the laparoscopic group (6%) and none of the patients in the robotic group. Median follow up was 15.6 and 5.9 months in the laparoscopic and robotic group, respectively. Conclusions Robot-assisted partial nephrectomy represents a safe and effective minimally-invasive treatment option for renal masses in patients with a Solitary Kidney. Early comparative outcomes suggest that it offers a significant benefit over the laparoscopic approach in terms of operative time, warm ischemia time and hospital stay. Further studies with a longer follow up are required to confirm the likelihood of better long-term functional and oncological outcomes.
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tumour in Solitary Kidney laparoscopic partial nephrectomy vs laparoscopic cryoablation
BJUI, 2012Co-Authors: Georgespascal Haber, Michael C Lee, Sebastien Crouzet, Kazumi Kamoi, Inderbir S. GillAbstract:Study Type – Therapy (cohort) Level of Evidence 2b What’s known on the subject? and What does the study add? Tumour in a Solitary functioning Kidney represents an absolute indication for nephron-sparing surgery whenever technically feasible. We report the longest follow-up data comparing laparoscopic partial nephrectomy and laparoscopic cryoablation in patients with Solitary Kidney with oncological follow-up to five years. OBJECTIVES • We compare perioperative, functional and intermediate-term oncological outcomes of laparoscopic partial nephrectomy (LPN) vs laparoscopic cryoablation (LCA) for small renal tumour in patients with a Solitary Kidney. • A treatment algorithm is also proposed. PATIENT AND METHODS • Over a 10-year period (02/1998-09/2008), 78 patients with a small tumour in a functionally Solitary Kidney underwent LPN (n= 48) or LCA (n= 30). • Baseline, perioperative, and follow-up data were collected prospectively and analyzed retrospectively. RESULTS • Demographic data were similar between the LPN and LCA groups. Tumours were somewhat larger (3.2 vs 2.6 cm) in the LPN group. LPN was associated with greater blood loss (391 vs 162 mL; P= 0.003), and trended towards more post-operative complications (22.9% vs 6.7%; P= 0.07). • By 3 months post-operative, eGFR decreased by 14.5% and 7.3% after LPN and LCA, respectively (P= 0.02). Post-operative temporary dialysis was required after 3 LPN (6.2% vs 0%, P= 0.16). • Median follow-up time for LPN and LCA was 42.7 and 60.2 months, respectively. • Local recurrence was detected in 4 (13.3%) LCA patients only (P= 0.02). • Overall survival was comparable between LPN and LCA at 3 and 5 years, respectively (P= 0.74). The LPN group had superior cancer-specific and recurrence-free survival at 3 and 5 years compared to the LCA group (P < 0.05, for all comparisons). CONCLUSIONS • Given adequate technical expertise, both LPN and LCA are viable nephron-sparing options for patients with tumour in a Solitary Kidney. • Although LCA is technically easier and has superior functional outcomes, oncologic outcomes are superior after LPN.
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functional outcomes following percutaneous surgery in the Solitary Kidney
The Journal of Urology, 2009Co-Authors: David Canes, Georgespascal Haber, Kazumi Kamoi, Nicholas J Hegarty, Andre Berger, Monish Aron, Mihir M DesaiAbstract:Purpose: We assessed the impact of percutaneous renal surgery on renal function based on the modification of diet in renal disease estimated glomerular filtration rate in Solitary renal units. We also determined the variables predictive of functional improvement or impairment following percutaneous surgery in Solitary Kidneys.Materials and Methods: A prospective database was augmented by retrospective chart review. Between 1984 and 2007, 81 patients with a Solitary Kidney, which was anatomical in 61.7%, functional in 18.5%, a transplant allograft in 11.1% and unknown in 8.6%, underwent a total of 92 percutaneous procedures. Serum creatinine was measured preoperatively, postoperatively, at 1 month and at 1 year. The 4-variable modification of diet in renal disease equation was used to calculate estimated creatinine clearance. The study population was divided into 3 groups, including group 1—a change in the estimated glomerular filtration rate of 5% or less at 1 year, group 2—an increase of greater than 5% ...
Pierre Cochat - One of the best experts on this subject based on the ideXlab platform.
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Towards adulthood with a Solitary Kidney
Pediatric Nephrology, 2019Co-Authors: Pierre Cochat, Olivia Febvey, Justine Bacchetta, Etienne Bérard, Natalia Cabrera, Laurence DubourgAbstract:Around 1/1000 people have a Solitary Kidney. Congenital conditions mainly include multicystic dysplastic Kidney and unilateral renal aplasia/agenesis; acquired conditions are secondary to nephrectomy performed because of urologic structural abnormalities, severe parenchymal infection, renal trauma, and renal or pararenal tumors. Children born with congenital Solitary Kidney have a better long-term glomerular filtration rate than those with Solitary Kidney secondary to nephrectomy later in life. Acute and chronic adaptation processes lead to hyperfiltration followed by fibrosis in the remnant Kidney, with further risk of albuminuria, arterial hypertension, and impaired renal function. Protective measures rely on non-pharmacological renoprotection (controlled protein and sodium intake, avoidance/limitation of nephrotoxic agents, keeping normal body mass index, and limitation of tobacco exposure). Lifelong monitoring should include blood pressure and albuminuria assessment, completed by glomerular filtration rate (GFR) estimation in case of abnormal values. In the absence of additional risk factors to Solitary Kidney, such assessment can be proposed every 5 years. There is no current consensus for indication and timing of pharmacological intervention.
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congenital versus acquired Solitary Kidney is the difference relevant
Nephrology Dialysis Transplantation, 2011Co-Authors: Pauline Abou Jaoude, Pierre Cochat, Justine Bacchetta, Laurence Dubourg, Julien Berthiller, Bruno RanchinAbstract:Background. Serious concerns have risen during the last decades regarding the potential role of Solitary Kidney (SK) in promoting systemic hypertension, proteinuria and glomerulosclerosis. The aim of the study was to assess mid- and long-term outcome of children with SK, with special highlight on the differential functional outcome of congenital and acquired forms of SK. Methods. Ninety-seven patients (43 females) aged from 2.9 to 25 years with radiologically normal SK were divided into two groups depending on whether they had a congenital (CSK, n = 44) or an acquired SK (ASK, n = 53). Mean follow-up time with SK was 8.3 ± 3.2 and 9.1 ± 4.4 years, respectively (P = NS). Blood pressure (BP), glomerular filtration rate (GFR) measured by inulin clearance, and microalbuminuria were assessed in all patients. Results. Two children (2%), one in each group, had systemic hypertension confirmed by 24-h ambulatory BP monitoring, and 17 (17.5%) had a significant microalbuminuria (8 in CSK and 9 in ASK, P = NS). The overall mean GFR was 100.6 ± 15 mL/min/1.73 m 2 and was found to be inversely correlated with age and follow-up time. Seven children had a GFR <80 mL/min/1.73 m , all had been nephrectomized in early childhood. Interestingly, GFR was higher in CSK than in ASK group (107.2 vs. 95.2 mL/min/1.73 m 2 , P < 0.01) and was negatively related to follow-up time only in the latter but not in the former group. Conclusions. In the light of these results, it appears that renal function in children with SK is well preserved in short and medium term, but it seems to decline gradually with longer periods of follow-up, particularly in ASK, thus assuming a better functional adaptation in CSK. Both conditions remain yet risky and predispose children to a greater incidence of hypertension and renal impairment in later life. Thereby, careful screening should be proposed throughout childhood to detect early signs of glomerular hyperfiltration and prevent its progression to more serious complications.
