Citations

624 Background: The risk of intravenous contrast induced nephropathy (CIN) is not well described in post-nephrectomy or metastatic kidney cancer. Patients with nephrectomies and tumors of the kidney frequently have CKD and often require serial contrast imaging placing them at risk for CIN. Methods: This is a retrospective review of 292 patients metastatic RCC and/or with partial or radical nephrectomies (PN or RN) for kidney tumors at Mayo Clinic Arizona or Florida from 2010 through 2014. Results: We found 207 patients received at least one contrast scan, of whom 99 had metastatic RCC, 104 had local RCC and 4 had oncocytoma. At baseline (pre-nephrectomy) 41% (46/113) and 15% (11/76) of RN and PN respectively had CKD stages 3-5 and with at least 3 months follow up after both nephrectomy and contrast exposure 61% (68/113) and 33% (25/76) RN and PN developed CKD stages 3-5 respectively. The median contrast exposure scans were 4 (range 1-30 scans) with a median follow up of 26 months (range 1-96 months). In all patients with at least one contrast exposure, the median change in creatinine and GFR from baseline was 0.2 mg/dL and 8 ml/min respectively. Excluding those with bilateral nephrectomy there were 8 (8/207 = 4%) CIN events, 6/113 had a radical nephrectomy and 2/76 with 1 partial nephrectomy and 1 aborted nephrectomy (P value 0.37). Of these patients 5 (5/99 = 5%) had metastatic RCC and 3 (3/104 = 3%) local RCC. The median contrast exposure scans for patients with CIN were 8 (range 3-12) and median follow up was 31 months (range 4-47 months). Three patients all with metastatic RCC developed acute kidney injury from CIN requiring dialysis and died of complications in part related to CIN during that hospital stay or soon after. Two other patients developed CKD stage III after CIN events and 3 patients (including the one with a partial nephrectomy) showed no significant change in GFR after CIN. Conclusions: In this retrospective analysis, CIN after nephrectomy or metastatic RCC contributed to acute renal failure with 3 deaths and 2 patients developing CKD stage III. Further analysis is required to determine what risk factors for CIN in this population.

The Internet has placed considerable information at the disposal of patients, but the sources for credible and accurate information may be difficult for a layperson to discern. Benign prostatic hyperplasia (BPH) in elderly men can be treated with different surgical interventions. The purpose of this research was to determine information seeking behaviors (ISB) of BPH patients before and after each type of surgery. All patients who underwent surgical intervention for BPH at a tertiary training center between January 2007 and January 2013 were included in this study. A comprehensive questionnaire regarding their ISB was sent through a third-party survey center. The following areas were examined: (1) the patient’s opinion regarding information sources of BPH and its treatment, (2) the extent of ISB for each patient and its relation to the type of surgical intervention he eventually underwent, and (3) the relationship between the extent of ISB and the patient’s final satisfaction. The results indicated that the majority of patients felt that it is relatively easy to find information about BPH and its treatment. Most of the patient started with either general online search engines or used the hospital website. Patients who explored more sources of information ended up choosing a more specific and sophisticated procedure. Generally, patients used fewer sources postoperatively regardless of the procedure they underwent. There was no correlation between the extent of ISB and overall satisfaction ( r = −0.0719, p = .1610) and regret ( r = −0.0436, p = .3945).

Purpose: To determine whether on-clamp partial nephrectomy (ON-PN) has any significant impact on long-term renal function in a two kidney model. Patients and Methods: From November 1999 to July 2013, 607 patients underwent PN at our institution. After excluding patients with solitary kidneys, multiple renal masses, and follow-up less than 90 days, 331 remained. Patient demographics were assessed, as was renal function based on pre- and postoperative mercaptoacetyltriglycine (MAG-3) renal scans and change in estimated glomerular filtration rate (eGFR) using the preoperative and most recent recorded creatinine levels. Results: There were a total of 236 patients who underwent ON-PN and 95 who underwent off-clamp PN (OFF-PN) during the study period. The longest follow-up was 12.6 years with mean follow-up of 3 years. Mean ischemia time of patients undergoing ON-PN was 25 minutes (range 8–63 min). No differences were noted between the ON-PN and OFF-PN cohorts with respect to estimated change in eGFR (ON-PN: −6.07 mL/min/1.73 m 2 vs OFF-PN: −6.00 mL/min/1.73 m 2 , P =0.69). No differences were noted in the % change in the MAG-3 renal scans (ON-PN: −0.77% vs OFF-PN: −1.1%, P =0.94). A post hoc sensitivity analysis of the same two variables stratified by age revealed no differences in change in estimated GFR or % change in differential function on renal scan. Conclusions: In the two kidney model, ischemia does not appear to affect long-term renal function outcomes after PN. These data provide evidence that ON-PN is perfectly acceptable in the appropriately selected patient with two kidneys.

Objective To determine if massive renal size should be a contraindication for attempting a laparoscopic approach to bilateral native nephrectomies in patients with autosomal dominant polycystic kidney disease ( ADPKD ). Patients and Methods We retrospectively reviewed all laparoscopic bilateral nephrectomies performed for ADPKD at our institution from 1 J anuary 2000 to 31 D ecember 2012. We stratified patients by kidney weight (with or without at least one kidney weighing >2500 g) and compared perioperative data, complications, and status of kidney allografts. Additionally, the subset of patients with at least one kidney weighing >3500 g was compared with the rest of the cohort. Results We identified 68 patients; mean (range) individual kidney weight was 1984 (197–5042) g. In all, 24 patients had at least one kidney weighing >2500 g, yet patients in this group were not significantly different from the rest of the cohort for complications, estimated blood loss, transfusion rate, or duration of hospitalisation. For those who underwent simultaneous renal allotransplantation, native kidney size was not associated with graft outcomes. Additionally, of the six patients with at least one kidney weighing >3500 g, only one required a blood transfusion, and the group had no intraoperative or postoperative Clavien grade ≥3 complications. None of the cohort required conversion to open surgery. Conclusion Massive size of polycystic kidneys is not a contraindication to attempting a laparoscopic approach to bilateral nephrectomies in an experienced, high‐volume centre.

ObjectiveTo examine the impact of body mass index, as a measure of obesity, on the surgical outcomes of cystectomy.MethodsThe American College of Surgeons National Surgical Quality Improvement Program database was used to acquire data on 1293 cystectomies carried out from 2005 to 2011. Patients were divided into two groups: body mass index <30 kg/m2 and ≥30 kg/m2. A propensity score‐matched analysis of perioperative outcomes was carried out.ResultsA total of 869 patients had a body mass index <30, whereas 424 had a body mass index ≥30. Unadjusted comparisons showed higher rates of superficial surgical site infections (8.7% vs 5.3%, P = 0.04), renal insufficiency (4.0% vs 1.7%, P = 0.01) and increased operative times (365.7 min vs 338.6 min, P = 0.0004) in the obese patients, but interestingly lower rates of pneumonia (2.4% vs 4.8, P = 0.03) and cerebral vascular accidents (0.0% vs 0.9%, P = 0.05). However, the latter two observations might be explained by more tobacco use among non‐obese patients (26.6 mean pack‐years vs 20.0 mean pack‐years, P = 0.004). Notably, no differences in 30‐day mortality were noted. After adjusting for preoperative demographic and clinical data using propensity score‐matching methods, there were no observed differences between the two cohorts except for operative time (P = 0.04).ConclusionsObesity is not independently associated with an increased risk of perioperative complications or 30‐day mortality after cystectomy.