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Franco A, Ditonno F, Feng C, Manfredi C, Sturgis MR, Farooqi M, Del Giudice F, Coogan C, Ferro M, Zhang C, Wu Z, Yang B, Wang L, Autorino R. Minimally Invasive Radical Nephroureterectomy: 5-Year Update of Techniques and Outcomes. Cancers (Basel) 2023; 15:4585. [PMID: 37760553 PMCID: PMC10527300 DOI: 10.3390/cancers15184585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 09/07/2023] [Accepted: 09/11/2023] [Indexed: 09/29/2023] Open
Abstract
The gold standard treatment for non-metastatic upper tract urothelial cancer (UTUC) is represented by radical nephroureterectomy (RNU). The choice of surgical technique in performing UTUC surgery continues to depend on several factors, including the location and extent of the tumor, the patient's overall health, and very importantly, the surgeon's skill, experience, and preference. Although open and laparoscopic approaches are well-established treatments, evidence regarding robot-assisted radical nephroureterectomy (RANU) is growing. Aim of our study was to perform a critical review on the evidence of the last 5 years regarding surgical techniques and outcomes of minimally invasive RNU, mostly focusing on RANU. Reported oncological and function outcomes suggest that minimally invasive RNU is safe and effective, showing similar survival rates compared to the open approach.
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Affiliation(s)
- Antonio Franco
- Department of Urology, Rush University, Chicago, IL 60612, USA; (A.F.); (F.D.); (C.F.); (C.M.); (M.R.S.); (M.F.); (C.C.)
- Department of Urology, Sant’Andrea Hospital, Sapienza University, 00189 Rome, Italy
| | - Francesco Ditonno
- Department of Urology, Rush University, Chicago, IL 60612, USA; (A.F.); (F.D.); (C.F.); (C.M.); (M.R.S.); (M.F.); (C.C.)
- Department of Urology, Azienda Ospedaliera Universitaria Integrata Verona, University of Verona, 37126 Verona, Italy
| | - Carol Feng
- Department of Urology, Rush University, Chicago, IL 60612, USA; (A.F.); (F.D.); (C.F.); (C.M.); (M.R.S.); (M.F.); (C.C.)
| | - Celeste Manfredi
- Department of Urology, Rush University, Chicago, IL 60612, USA; (A.F.); (F.D.); (C.F.); (C.M.); (M.R.S.); (M.F.); (C.C.)
- Urology Unit, Department of Woman, Child and General and Specialized Surgery, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy
| | - Morgan R. Sturgis
- Department of Urology, Rush University, Chicago, IL 60612, USA; (A.F.); (F.D.); (C.F.); (C.M.); (M.R.S.); (M.F.); (C.C.)
| | - Mustafa Farooqi
- Department of Urology, Rush University, Chicago, IL 60612, USA; (A.F.); (F.D.); (C.F.); (C.M.); (M.R.S.); (M.F.); (C.C.)
| | - Francesco Del Giudice
- Department of Maternal Infant and Urologic Sciences, Policlinico Umberto I Hospital, “Sapienza” University of Rome, 00161 Rome, Italy;
| | - Christopher Coogan
- Department of Urology, Rush University, Chicago, IL 60612, USA; (A.F.); (F.D.); (C.F.); (C.M.); (M.R.S.); (M.F.); (C.C.)
| | - Matteo Ferro
- Division of Urology, European Institute of Oncology (IEO), IRCCS, 20141 Milan, Italy;
| | - Chao Zhang
- Department of Urology, Changhai Hospital, Naval Medical University, Shanghai 200433, China; (C.Z.); (Z.W.); (B.Y.); (L.W.)
| | - Zhenjie Wu
- Department of Urology, Changhai Hospital, Naval Medical University, Shanghai 200433, China; (C.Z.); (Z.W.); (B.Y.); (L.W.)
| | - Bo Yang
- Department of Urology, Changhai Hospital, Naval Medical University, Shanghai 200433, China; (C.Z.); (Z.W.); (B.Y.); (L.W.)
| | - Linhui Wang
- Department of Urology, Changhai Hospital, Naval Medical University, Shanghai 200433, China; (C.Z.); (Z.W.); (B.Y.); (L.W.)
| | - Riccardo Autorino
- Department of Urology, Rush University, Chicago, IL 60612, USA; (A.F.); (F.D.); (C.F.); (C.M.); (M.R.S.); (M.F.); (C.C.)
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Rath L, Jokisch F, Schulz GB, Kretschmer A, Buchner A, Stief CG, Weinhold P. Combined Open Prostatectomy and Kidney Surgery: Feasibility and 12-Month Outcome. Res Rep Urol 2021; 13:815-821. [PMID: 34849371 PMCID: PMC8627302 DOI: 10.2147/rru.s341823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 11/09/2021] [Indexed: 12/24/2022] Open
Abstract
Purpose There are only a few case reports and case series that investigated combined laparoscopic or robotic surgery for simultaneous prostate and kidney cancer. In this study, we want to close a gap in existing research to assess the feasibility and oncological outcome of combined open prostatectomy and kidney surgery. Methods We retrospectively analyzed patients who underwent a combined open prostatectomy and either a partial or complete nephrectomy from 2013 to 2020. Descriptive statistics were used to assess perioperative parameters and the 12-month functional and oncological outcomes after combined surgery. Results We identified 10 patients undergoing combined open surgery. Partial nephrectomy was performed in 4, radical nephrectomy in 6 patients. For prostate cancer, histopathological analysis showed a tumor stage ≥ pT2c in all 10 patients. For renal tumors, histopathological analysis showed clear cell renal cell carcinoma in 8 patients and oncocytoma in 2 patients. Operating time was 177 ± 36 minutes. Two perioperative complications (Clavien 2a and 3) were observed. Three months postoperatively, the International Index of Erectile Function (IIEF-5) score was 5.6 ± 5.9, the ICIQ-SF score was 7.3 ± 5.6 and were using 1.9 ± 2.2 pads per day. This improved after 12 months postoperatively, as patients had an IIEF-5 score of 6.33 ± 6.5, an ICIQ-SF score of 4.4 ± 5.7 and were using pads 0.9 ± 1.7 per day. Conclusion In this study, we showed that open surgery is a safe and valid approach for combined prostatectomy and renal surgery with acceptable complications and oncological outcomes. The combined open approach could be a good alternative to combined laparoscopic/robotic surgery in this field, especially to treat patients with advanced renal tumors or previous abdominal surgery or radiation.
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Affiliation(s)
- Lukas Rath
- Department of Urology, Ludwig-Maximilians-University, Munich, Germany
| | - Friedrich Jokisch
- Department of Urology, Ludwig-Maximilians-University, Munich, Germany
| | | | | | - Alexander Buchner
- Department of Urology, Ludwig-Maximilians-University, Munich, Germany
| | - Christian G Stief
- Department of Urology, Ludwig-Maximilians-University, Munich, Germany
| | - Philipp Weinhold
- Department of Urology, Ludwig-Maximilians-University, Munich, Germany
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Greco F, Marchioni M, Esperto F, Papalia R, Schips L, Scarpa RM. How Targeted Therapy Influence Renal Surgery for Renal Cell Carcinoma. Curr Drug Targets 2020; 21:1550-1557. [PMID: 32621715 DOI: 10.2174/1389450121666200704150933] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Revised: 05/11/2020] [Accepted: 05/18/2020] [Indexed: 11/22/2022]
Abstract
Between the end of 2005 and the beginning of 2006, several new target therapies have been introduced for the treatment of renal cell carcinoma. In this review, we aimed to explore and summarize the main findings of the use of systemic treatment and its effect on surgery in patients with renal cell carcinoma. We identified three different settings: neoadjuvant and adjuvant settings as well as the association of systemic therapy with surgery in the metastatic renal cell carcinoma patients. Neoadjuvant target therapy with tyrosine kinase inhibitor may facilitate the tumor resection and reduce the overall tumor diameter and its complexity. However, most of the evidence is from small phase I or II clinical trials and results are often conflicting without determining a relevant change in the main parameters investigated, such as tumor complexity. In the adjuvant setting, results from pivotal trials investigating the use of tyrosine kinase inhibitors for patients with non-metastatic RCC treated with surgery discourage this practice. Indeed, most of the evidence from single clinical trials and pooled results from meta-analysis failed to find a survival advantage with the use of adjuvant systemic treatment. To date, an improvement of clinical outcomes after systemic targeted therapies could be only found in the setting of cytoreductive nephrectomy. However, the CARMENA and SURTIME trials recently confirmed the evidence against a surgical treatment in patients with mRCC and poor prognosis. In the near future, significant changes may be introduced by the use of immunotherapies.
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Affiliation(s)
- Francesco Greco
- Department of Urology, Humanitas Gavazzeni, Bergamo, Italy,School of Medicine and Surgery, Humanitas University, Milan, Italy
| | - Michele Marchioni
- Department of Medical, Oral and Biotechnological Sciences, "G. d'Annunzio" University of Chieti, "SS. Annunziata" Hospital, Urology Unit, Chieti, Italy
| | - Francesco Esperto
- Department of Urology, Campus Biomedico, University of Rome, Rome, Italy
| | - Rocco Papalia
- Department of Urology, Campus Biomedico, University of Rome, Rome, Italy
| | - Luigi Schips
- Department of Medical, Oral and Biotechnological Sciences, "G. d'Annunzio" University of Chieti, "SS. Annunziata" Hospital, Urology Unit, Chieti, Italy
| | - Roberto M Scarpa
- Department of Urology, Campus Biomedico, University of Rome, Rome, Italy
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Sirithanaphol W, Pachirat K, Rompsaithong U, Kiatsopit P, Ungareevittaya P, Chindaprasirt J. Perioperative outcomes in elderly patients undergoing nephrectomy for renal cell carcinoma. Res Rep Urol 2019; 11:195-199. [PMID: 31440483 PMCID: PMC6664253 DOI: 10.2147/rru.s220221] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Accepted: 07/08/2019] [Indexed: 12/13/2022] Open
Abstract
Purpose To determine if age should be considered a relative contraindication to surgery for safety reasons. Methods Renal cell carcinoma (RCC) patients who underwent nephrectomy from January 2007 to December 2017 were analyzed retrospectively. Patients were grouped into age<65 and age≥65 years. The demographic data, surgical outcomes, complication, hospital stay, blood loss, and survival were compared between the two groups. Results A total of 101 patients were included; 74 in the younger group, and 27 in the older group. Compared to the young group, lower BMI, higher anemia, higher ASA grade, and comorbidities were frequent in the elderly. The operative time, blood loss, and renal function decline were comparable between two age groups. The complication rates in the older and younger group were 22% and 12%, respectively. The survival time was shorter in older patients compared to the younger ones; hazard ratio 2.25; 95%CI 1.08–4.69, p-value=0.031. Conclusion Nephrectomy in elderly patients is safe and feasible and preoperative assessment along with diligent postoperative care may further increase survival. Age alone cannot be regarded as a contraindication for nephrectomy in RCC.
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Affiliation(s)
- Wichien Sirithanaphol
- Division of Urologic Surgery, Department of Surgery, Khon Kaen University, Khon Kaen, Thailand
| | - Kachit Pachirat
- Division of Urologic Surgery, Department of Surgery, Khon Kaen University, Khon Kaen, Thailand
| | - Ukrit Rompsaithong
- Division of Urologic Surgery, Department of Surgery, Khon Kaen University, Khon Kaen, Thailand
| | - Pakorn Kiatsopit
- Division of Urologic Surgery, Department of Surgery, Khon Kaen University, Khon Kaen, Thailand
| | | | - Jarin Chindaprasirt
- Medical Oncology Division, Department of Internal Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
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Huang J, Zhang D, Li SJ, Xi Y, Cui LY, Gao FL. Preoperative practice of surgical position reduces postoperative pain and discomfort in patients receiving kidney surgeries: a nonrandomized pilot study. Ther Clin Risk Manag 2018; 14:1111-1114. [PMID: 29942133 PMCID: PMC6005319 DOI: 10.2147/tcrm.s152836] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Objective Prolonged maintenance of surgical position often results in postoperative pain and discomfort in patients. The present study aimed to investigate the effect of preoperative practice of surgical position on postoperative pain and general comfort in patients receiving kidney surgeries. Methods For this nonrandomized pilot study, 74 patients receiving kidney surgeries were selected using the probability sampling method. Patients from ward 1 were assigned to the practice group (n=35), and those from ward 2 were assigned to the control group (n=39). The practice group were instructed to practice the surgical position for 3 days prior to the surgery. Postoperative pain and comfort were surveyed using two questionnaires for 3 days, respectively. The postoperative pain scores were compared using the Student's t-test. Results The two groups did not differ significantly in wound pain on postoperative days 1-3 (P > 0.05). However, the practice group showed significantly reduced low back pain and contralateral shoulder pain than the control group for 3 postoperative days (P < 0.05). The physical domain score was significantly higher in the practice group than in the control group (P < 0.01). Conclusion Preoperative practice of surgical position can effectively reduce postoperative low back pain and contralateral shoulder pain in patients receiving kidney surgeries and improve the physical comfort.
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Affiliation(s)
- Jing Huang
- Department of Urology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Dan Zhang
- Department of Nephrology, Beijing, Chao-Yang Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Shu-Jing Li
- Department of Urology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Ying Xi
- Department of Urology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Li-Yan Cui
- Department of Urology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Feng-Li Gao
- Department of Nursing, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, People's Republic of China
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Abstract
BACKGROUND The 2008 American Urological Association (AUA) Best Practice Statement on antimicrobial prophylaxis states that prophylaxis is not warranted for subjects with normal risk profile undergoing cystourethroscopy unless manipulation such as ureteral stent removal is performed. To date no studies have specifically assessed the need for antimicrobial prophylaxis during cystoscopic ureteral stent removal. We sought to determine the risk of infectious complications following cystoscopic stent removal with and without antimicrobial prophylaxis. METHODS A retrospective review identified 70 subjects who underwent cystoscopic ureteral stent removal following kidney stone treatment, under the care of two separate urologists with differing practice patterns. Each cohort consisted of 35 subjects: with and without prophylactic antibiotics. Clinical variables assessed included demographics, type of stone intervention, prior urinary tract infection (UTI) history, immunocompromising comorbidities, antimicrobial class at time of stone intervention, and antimicrobial administration at cystoscopic stent removal. The primary outcome assessed was development of symptomatic UTI within 4 weeks after stent removal. RESULTS Overall, 35 patients (50%) received antimicrobial prophylaxis at the time of stent removal and 35 (50%) did not receive antimicrobial prophylaxis, with no demographic or clinical differences between cohorts. Two patients in the antimicrobial cohort (6%) developed a UTI and none of the patients who did not receive antimicrobial prophylaxis developed a UTI (P=0.15). CONCLUSIONS In our cohort study antimicrobial prophylaxis at the time of cystoscopic stent removal did not appear to provide a significant benefit in UTI prevention. Prospective studies would assist in validating these findings.
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Affiliation(s)
- Joel E Abbott
- Department of Urology, University of California, San Diego, San Diego, CA, USA
| | - Allison Han
- University of California San Diego School of Medicine, San Diego, CA, USA
| | - Michelle McDonald
- Department of Urology, University of California, San Diego, San Diego, CA, USA
| | - Charlie Lakin
- Department of Urology, University of California, San Diego, San Diego, CA, USA
| | - Roger L Sur
- Department of Urology, University of California, San Diego, San Diego, CA, USA
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Silberstein JL, Sprenkle PC, Su D, Power NE, Tarin TV, Ezell P, Sjoberg DD, Feifer A, Fleisher M, Russo P, Touijer KA. Neutrophil gelatinase-associated lipocalin (NGAL) levels in response to unilateral renal ischaemia in a novel pilot two-kidney porcine model. BJU Int 2013; 112:517-25. [PMID: 23510358 DOI: 10.1111/bju.12066] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVES To test a novel porcine two-kidney model for evaluating the effect of controlled acute kidney injury (AKI) related to induced unilateral ischaemia on both renal units (RUs) To use neutrophil gelatinase-associated lipocalin (NGAL) and physiological serum and urinary markers to assess AKI and renal function. METHODS Twelve female Yorkshire pigs had bilateral cutaneous ureterostomies placed laparoscopically with identical duration of pneumoperitoneum for all cases. An experimental group (n = 9) underwent induced unilateral renal ischaemia with left hilar clamping of timed duration (15, 30, 60 min) and a control group (n = 3) had no induced renal ischaemia. Urine was collected and analysed from each RU to assess creatinine and NGAL concentration preoperatively and at multiple postoperative time points. Serum was collected and analysed daily for creatinine and NGAL levels. Statistical comparisons were made using the rank-sum and sign-rank tests. RESULTS Three pigs were excluded because of intra-operative and postoperative complications. In the RUs that experienced renal ischaemia (n = 7),the median urine volume was lower (P = 0.04) at 6, 12, 24 and 48 h and the median NGAL concentration was higher (P = 0.04) at 12 and 48 h compared with the RUs of control pigs that experienced no renal ischaemia (n = 2). When comparing the ischaemic (left) RU of the pigs in the experimental group with their contralateral non-ischaemic (right) RU, ischaemic RUs had a lower median cumulative urine volume at 6, 12, 24 and 48 h (P = 0.05) and a higher median NGAL concentration at 12, 24 and 48 h (P < 0.05). At 48 h, no significant increase was found in serum NGAL in pigs in the experimental group compared with controls (P = 0.2). Creatinine clearance (CC) was lower in ischaemic RUs compared with non-ischaemic RUs 1 day after surgery (P = 0.04) with decreasing CC as the duration of ischaemia increased. CONCLUSIONS We have developed a promising novel small-scale pilot surgical model that allowed the evaluation of bilateral RU function separately during and after unilateral renal ischaemia. The induction of unilateral renal ischaemia corresponds with physiological changes in both the ischaemic and contralateral RU. AKI as measured by increases in NGAL and decreased renal function as measured by decreases in CC, are specific to the RU exposed to ischaemia.
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Affiliation(s)
- Jonathan L Silberstein
- Department of Surgery, Urology Service, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
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