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Impact of Warm Ischemia on Renal Function - Clinical Model of Tumor Resection of Solitary Kidney
Stránský, Petr ; Hora, Milan (advisor) ; Broďák, Miloš (referee) ; Doležel, Jan (referee)
Objective: The aim of this work is to evaluate the effect of warm ischemia on renal function. Methods: Within a multicentric study, the data about tumor-affected solitary kidney were obtained from 9 urological centers in the Czech Republic. Patients were divided into groups according to the WIT (warm ischemia time). In each group the mean preoperative serum creatinine was determined, as well as on 3rd and 7th postoperative day and the lowest GF postoperatively. In each group the mean R.E.N.A.L. nephrometric score was determined. Results: The study compriese data totally of 97 patients. The open approach was chosen in 78 cases, in 16 cases laparoscopic approach was chosen. The robotic surgery was performed in 3 patients. PN with zero ischemia was performed in 29 patients (30%). Conclusion: Our findings confirm that non-clamping partial nephrectomy in a solitary kidney minimizes renal injury. For the non-clamping partial nephrectomy can be mainly indicated smaller exophyticall tumors without deep parenchymal invasion. Unfortunately, most of PN should be performed with vascular clamping, allowing precise closure of collecting system, vascular and parenchymal defect, especially for larger tumors with deep parenchymal invasion. According to our observation that WIT of 15 minutes for a kidney is safe. Clamping of...
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Impact of Warm Ischemia on Renal Function - Clinical Model of Tumor Resection of Solitary Kidney
Stránský, Petr ; Hora, Milan (advisor) ; Broďák, Miloš (referee) ; Doležel, Jan (referee)
Objective: The aim of this work is to evaluate the effect of warm ischemia on renal function. Methods: Within a multicentric study, the data about tumor-affected solitary kidney were obtained from 9 urological centers in the Czech Republic. Patients were divided into groups according to the WIT (warm ischemia time). In each group the mean preoperative serum creatinine was determined, as well as on 3rd and 7th postoperative day and the lowest GF postoperatively. In each group the mean R.E.N.A.L. nephrometric score was determined. Results: The study compriese data totally of 97 patients. The open approach was chosen in 78 cases, in 16 cases laparoscopic approach was chosen. The robotic surgery was performed in 3 patients. PN with zero ischemia was performed in 29 patients (30%). Conclusion: Our findings confirm that non-clamping partial nephrectomy in a solitary kidney minimizes renal injury. For the non-clamping partial nephrectomy can be mainly indicated smaller exophyticall tumors without deep parenchymal invasion. Unfortunately, most of PN should be performed with vascular clamping, allowing precise closure of collecting system, vascular and parenchymal defect, especially for larger tumors with deep parenchymal invasion. According to our observation that WIT of 15 minutes for a kidney is safe. Clamping of...
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