Five year review of open radical nephrectomies at a regional hospital in South Africa: room for improvement

Background:To review the presentation and outcomes of patients undergoing open radical nephrectomy (ORN) for renal cell carcinoma (RCC) at a regional hospital in KwaZulu-Natal, South Africa.Methods:A retrospective chart review was performed of patients having undergone nephrectomy at St Aidan's hospital between 2010 and 2015, focusing on those with RCC. Demographic, operative, histopathology and outcomes data were collected.Results:Fifty-two patients (51%) had ORN for suspected malignant disease. Forty-one RCCs were found including one incidental finding at simple nephrectomy. Data was insufficient to assess risk factors for RCC. HIV positive patients tended to present earlier (45 vs. 53 years). The mean tumour size was 10 cm and organ confined disease was present in 73.2% of patients. Only 11 patients (26.8%) had pT1 disease. The high-grade complication rate was 9.8%, in-hospital mortality rate 4.9% and transfusion rate 51.2%. The median operating time was 1h 50min and length of hospital stay 13 days.Conclusions:Open radical nephrectomy is the standard surgical treatment for RCC at regional level in South Africa. Patients tend to present at a younger age, particularly if HIV positive, and with large tumours. Further research into risk factors for RCC in the South African population is needed. There are high complication and transfusion rates in patients undergoing ORN. Review of accessibility of blood at St Aidan's hospital and revision of the transfusion protocol is suggested. A follow-up study to assess the feasibility and cost-effectiveness of laparoscopic nephrectomy in the resource-constrained South African environment is necessary

Correlation between radiological and histopathological findings in patients undergoing nephrectomy for presumed renal cell carcinoma on computed tomography scan at Grey's Hospital

Background: The incidence of renal cell carcinoma (RCC) is increasing globally owing to the increased use of cross-sectional imaging. Computed tomography (CT) scan is the modality of choice in the diagnosis and pre-operative assessment of RCC. Nephrectomy is the standard treatment for RCC and pre-surgery biopsy is not routinely practised. The accuracy of CT diagnosis and staging in a South African population has not been established. Objectives: To determine the accuracy of CT scan in the diagnosis and pre-operative staging of RCC at Grey's Hospital. Methods: A retrospective chart review was performed; CT scan reports and histopathological results of adult patients who underwent nephrectomy for presumed RCC on CT scan between January 2010 and December 2016 were compared. Results: Fifty patients met the inclusion criteria for the study. CT significantly overestimated the size of renal masses by 0.7 cm (p = 0.045) on average. The positive predictive value of CT for RCC was 81%. Cystic tumours and those 4 cm and smaller were more likely to be benign. CT demonstrated good specificity for extra-renal extension, vascular invasion and lymph node involvement, but poor sensitivity. Conclusion: In our South African study population, CT is accurate at diagnosing RCC, but false-positives do occur. Non-enhancing or poorly enhancing, cystic, fat-containing and small lesions (4 cm or smaller) are more likely to be benign and ultrasound-guided biopsy should be considered to avoid unnecessary surgery. CT assessment of extra-renal extension and vascular invasion is challenging and additional imaging modalities such as magnetic resonance imaging (MRI) venogram, duplex Doppler ultrasound or Positron emission tomography­computed tomography (PET/CT) may be beneficial

Extraperitoneal (RT) Renal Ectopia ­ asymptomatic case report

Renal ectopia anatomically results from altered migration of kidneys to their normal position in the lumbar region. Few case reports have been reported in literature. Visceral-tissue variation was in form of quadratus lumborum and psoas major in place of the RT kidney. A 21 year old female with positive HCG (pregnancy test) presented for radiological (ultrasound) confirmation of cyesis, though no sonic evidence of gravidae was observed (< 5 wks GA); confirmatory ectopic kidney was diagnosed on completion of ultrasound. This report underscores the importance of imaging the RT groin and illiac region before surgical intervention thus preventing iatrogenic injury genesis. Treatment of this condition will depend on the functional capacity of the kidney, while nephrectomy is recommended for 'static' non-functional kidneys. Non-complicated cases and anatomic variation can be managed conservatively

Hydronephrose geante à propos de trois observations au CHU Hubert Maga de Cotonou

Introduction : Les hydronephroses geantes sont rares mais non exceptionnelles. Le but de cette etude est de rapporter la frequence de l'affection dans le service d'Urologie et de decrire la tactique operatoire de trois etiologies. Observations No 1 : Mme Nadine H.; 26 ans; admise le 2/ 06 /06 pour douleurs et masse du flanc gauche. Le debut de sa maladie remonte a 8 ans marque par des crises de colique nephretique gauche et de pyelonephrite gauche. Ses antecedents sont sans particularite. L'examen physique ote un bon etat general; dans le service. Elle atteint les deux sexes. Le sex-ratio est de 3 hommes pour 1 femme. L'age moyen est de 21 ans. Le cote dominant est gauche chez la femme et droit chez l'homme. La masse d'un flanc; la douleur; l'hyperthermie et l'hematurie sont les principaux motifs de consultation. L'examen clinique decouvre la masse qui donne le contacte lombaire et le ballottement renal. L'echographie et l'urographie intraveineuse sont la cle du diagnostic. La tactique operatoire est representee par la pyeloplastie et la nephrectomie quand le rein est detruit. Conclusion : L'hydronephrose geante est rare. Le retard a la consultation est un facteur de mauvais pronostic fonctionnel. La masse d'un flanc; la douleur; l'hematurie; la fievre et l'urinome retroperitoneal en sont evocateurs. Dans les meilleurs cas; la pyeloplastie est une solution sinon la nephroureterectomie. Une masse du flanc gauche donnant un contacte lombaire et un ballottement renal. L'echographie et l'urographie intraveineuse revelent une hydronephrose geante. Une pyeloplastie est faite. Les suites sont simples. No 2 : Mme Catherine G.; 55 ans; obese; hypertendue et diabetique; est admise le 27/10/06 pour des douleurs febriles du flanc gauche; evoluant depuis 5 ans sur un fond d'hyperthermie. L'examen physique note un bon etat general; une masse ovoide du flanc gauche; donnant un contact lombaire et un ballottement renal. L'echographie renale et l'urographie intraveineuse revelent une hydronephrose geante lithiasique. Une nephrectomie gauche est pratiquee. Les suites sont simples. No3 : Mlle Tatiana A.; 19 ans; admise le /10 / 05 pour masse abdominale gauche; douleurs et hyperthermie a 39oC. Dans ses antecedents; existe une laparotomie blanche pour une suspicion de kyste de l'ovaire gauche depuis deux jours. L'examen clinique revele une alteration de l'etat general; une temperature a 39oC; une plaie fraiche de laparotomie. La fosse lombaire gauche est comblee; donnant un contacte lombaire et un ballottement renal. Le membre pelvien gauche est en psoitis et une hydrocele du canal de Nuck gauche. L'echographie et l'urographie intraveineuse montrent une hydronephrose geante ectopique. Une nephrectomie gauche est realisee. Une operation de Hartmann est faite pour lesion iatrogene du colon sigmoide avec un retablissement de continuite trois mois plus tard. Les suites sont simples. Discussion : L'hydronephrose geante est une pathologie rare mais non exceptionnelle. Sa frequence est de 0;05 dans le service. Elle atteint les deux sexes. Le sex-ratio est de 3 hommes pour 1 femme. L'age moyen est de 21 ans. Le cote dominant est gauche chez la femme et droit chez l'homme. La masse d'un flanc; la douleur; l'hyper- thermie et l'hematurie sont les principaux motifs de consultation. L'examen clinique decouvre la masse qui donne le contacte lombaire et le ballottement renal. L'echographie et l'urographie intraveineuse sont la cle du diagnostic. La tactique operatoire est representee par la pyeloplastie et la nephrectomie quand le rein est detruit. Conclusion : L'hydronephrose geante est rare. Le retard a la consultation est un facteur de mauvais pronostic fonctionnel. La masse d'un flanc; la douleur; l'hematurie; la fievre et l'urino- me retroperitoneal en sont evocateurs. Dans les meilleurs cas; la pyeloplastie est une solution sinon la nephroureterectomie

Les complications de la nephrectomie laparoscopique

Objectif: Depuis l'avenement de la chirurgie minimale invasive; la voie laparoscopique devient la reference pour le traitement chirurgical des pathologies renales. L'objectif de ce travail est d'analyser les complications de la nephrectomie laparoscopique. Patients et methodes: Les nephrectomies laparoscopiques realisees en 10 ans (1996 - 2005) ont ete revues. Les caracteres demographiques; les incidents per-operatoires et les complications post-operatoires ont ete etudies. Resultats: Il y avait 181 patients operes dont 83 nephrectomies radicales; 80 nephrectomies simples et 18 nephro-ureterectomies. L'age moyen est de 59 ans. Des antecedents de chirurgie et/ou de radiotherapie etaient observes chez 103 patients (56;91). Chez 25 patients (13;81); on notait au moins une complication. Une conversion etait necessaire chez 6 patients (3;31) avec 4 plaies vasculaires et 2 difficultes de dissection. Dans 10 cas (5;52); les complications etaient majeures (8 cas de saignements; 1 cas d'odeme aigu des poumons; 1 cas de fistule digestive) avec 2 deces. Chez 15 patients (8;29); elles etaient mineures avec 9 cas d'hematome; 3 cas d'infection parietale; 2 cas d'emphyseme sous cutanee et 1 cas d'eventration lombaire. Conclusion: Le taux global de complications est de 13;81. Il semblerait que l'existence de facteurs de risque associes (age avance; tares; antecedents chirurgicaux ou irradiation) augmente le taux de complication. Le profil de ces patients est un des elements a prendre en compte pour prevoir et prevenir ces complications

Angiomyolipoma : a report of two cases

Objective: We report two cases of unusual renal tumours in two Nigerian adults. The first case was in a 45 year old female; who presented with an insidious onset of right upper abdominal pain with right abdominal swelling. The second case was a 33 year old pregnant lady; presenting with three week history of right lumbar pain and an accompanying mass. The various modes of radiological investigations and their significance in making a prompt diagnosis are highlighted. Method: Abdominal ultrasound scan; intravenous urography and CT scan confirmed the presence of renal masses in both cases and the suspicion of renal malignancies were raised clinically. They both had nephrectomy. Results : Histology report of the masses revealed angiomyolipoma (AML). Conclusions: In a period of three years; out of twenty four solid renal tumours operated upon in the Lagos State University Teaching Hospital (LASUTH); two were unusual. All the others were renal cell carcinoma. All diagnosis were confirmed histologically

Comparaison de la chirurgie conservatrice et de la nephrectomie totale elargie dans le traitement du cancer du rein : experience Lyonnaise

Objective: Due to the good results obtained during the past 20 years with conservative surgery for the treatment of renal cell carcinoma and the increasing number of cases of small sized renal tumors many authors advocate nephron-sparing surgery as procedure of choice in selected cases. Others underline the risk of multifocality and thus the risk of recurrence and still consider radical nephrectomy the gold standard. We present the results of a retrospective study including two groups of 62 patients each operated on for renal cell carcinoma at our department: Group 1 underwent conservative surgery (CS) and Group 2 had a radical nephrectomy (RN). Patients and Methods: Between 1988 and 1999; more than 900 patients with renal cell carcinoma were operated at our institution. Considering two groups of 62 matching patients each; we compared the results of conservative surgery (partial nephrectomy and/or tumorectomy) to those of radical nephrectomy in terms of morbidity; renal function; disease control and survival. The patients were matched according to sex; date of intervention; nuclear grade; pathological stage (UICC classification 1997). Results: The median follow-up was 5 years in both groups. The mean age was 61 years; the sex ratio = 1: 2; 2. For both groups; pathological stage and nuclear grade were distributed as follows: pT1 and pT2: 78; pT3 a 16; pT3b 4; pT3c 2. Fuhrman grade 1 and 2: 77; 3 and 4: 23. Morbidity: Mean hospitalization was 15;5 days for Group 1 (CS) and 11 days for Group 2 (RN) (p= 0;03). The transfusion rate was 30for Group 1 and 5for Group 2 (p 0;001). There was no difference between the two groups in terms of variation of serum creatinine level before and after surgery. The complication rate was 32and 8for Groups 1 and 2; respectively (p

Aspects anatomopathologiques observes au cours des nephrectomies au CHU de Brazzaville (Congo)

De janvier 1990 a decembre 1993 soit en 4 ans; trente (30) pieces de nephrectomie ont ete enregistrees et examinees dans le Service d'Anatomie et de Cytologie Pathologiques; du CHU de Brazzaville. Les pathologies renales qui ont conduit a la nephrectomie frappent egalement l'homme et la femme (50 per cent de cas). Les aspects anatomo-pathologiques sont polymorphes; dominees par l'inflammation (53;4 per cent). Selon l'age; les lesions histologiques observees entre 0 et 20 ans sont dominees par le nephroblastome (9 cas) suivies des pyelonephrites (4 cas) et exceptionnellement le carcinome renal a cellules claires (1 cas). Apres 20 ans les lesions inflammatoires a type de pyelonephrites par obstruction calculeuse sont predominantes (12 cas); secondairement viennent les carcinomes renaux a cellules claires (2 cas). Les tumeurs benignes (cystadenome; lipomyofibrome) sont rares