The Effectiveness of Simultaneous Renal Artery-vein Clamping during Laparoscopic Partial Nephrectomy on the Surgical Outcome / 대한비뇨기과학회지

PURPOSE: We wanted to compare the surgical outcomes of laparoscopic partial nephrectomy(LPN) performed with and without simultaneous artery-vein clamping. MATERIALS AND METHODS: Between April 2005 and December 2006, elective LPN was performed for 56 patients with renal tumors with using hilar clamping by a Satinsky clamp in 42(75%) patients, and with using artery-only or no clamping in the rest of the patients. The Satinsky and non-Satinsky groups were compared for their perioperative characteristics, the pathologic findings and the complication rate. The postoperative renal function was evaluated with measuring the serum creatinine and also by 99technetium labeled diethylenetetraminepentaacetic acid(DTPA) renal scanning. RESULTS: Renal cell carcinoma was diagnosed in 43(76.8%) patients and all had negative margins. There were no significant differences between the two groups for tumor size(2.1 vs. 2.0cm, respectively), the operative time(210.9 vs. 199.3 min, respectively) and the hospital stay(5.9 vs. 5.6 days, respectively). The mean warm ischemia time was longer when the Satinsky clamp was applied(38.5 vs. 21.9 min, respectively, p=0.03). The postoperative serum creatinine level and glomerular filtration rate(GFR) were 1.13mg/dl and 41.4ml/min/m2, respectively, in the Satinsky group and 1.17mg/dl and 33.5ml/min/m2, respectively, in the non-Satinsky group, without significant differences. The postoperative transfusion rate was lower in the Satinsky group(9.5 vs. 28.5%, respectively, p=0.28), although more pelvocalyceal system repair was done in the Satinsky group (47.6 vs. 7.7%, respectively, p=0.006). CONCLUSIONS: Simultaneous clamping of the renal artery and vein during LPN enables efficient removal of tumors that are deep in the renal sinus with a safe margin, it facilitates closure of the pelvocalyceal system and it reduces the need for transfusion without impairing renal function.

Impact of Vesico-ureteral Reflux on Renal Function after a Radical Cystectomy: a Comparison of Refluxing and Antirefluxing Orthotopic Bladder Substitutes / 대한비뇨기과학회지

PURPOSE: We evaluated the incidence and impact of vesico-ureteral reflux(VUR) on renal function after a radical cystectomy and the use of orthotopic bladder substitutes, using refluxing and antirefluxing type uretero-intestinal anastomosis. MATERIALS AND METHODS: Sixty-five patients(124 renal units) had undergone a radical cystectomy with an ileal orthotopic substitute and received postoperative follow-up for longer than 12 months. For these patients, we evaluated the presence and grade of VUR using voiding cystourethrography(VCUG) and measured the individual glomerular filtration rate (GFR) of the corresponding renal units using a (99m)technetium diethylenetetraminepentaacetic acid(DTPA) renal scan. According to the urinary diversion(refluxing or antirefluxing methods), we analyzed the incidence of VUR and the impact of VUR on renal function. The mean follow-up time was 52 months(range 13-132 months) after surgery. RESULTS: The incidence of VUR was higher in the refluxing anstomosis group(group R, 60.3%) of patients than in the antirefluxing group of patients(group NR, 21.7%)(p=0.001). However, the mean GFR was not significantly different(72.5ml/min/m2 for group R patients, 76.4ml/min/ m2 for group NR patients, respectively). Between the refluxing and nonrefluxing renal units, no significant difference of GFR was also noted (38.3ml/min/m2 versus 37.7ml/min/m2). When GFR was stratified by the duration of the diversion, it was not significantly different (38.2, 36.2, and 41.7ml/min/m2 at 12-24, 25-48 and > 48 months, p>0.05, respectively) regardless of the diversion methods. The degree of reflux was not related to the renal function. CONCLUSIONS: Although there was a higher incidence of VUR in the refluxing type than in the antirefluxing type of orthotopic bladder substitutes, VUR developing after a radical cystectomy does not significantly alter renal function regardless of its severity or the methods and duration of the diversion.

Factors Modulating Responses to Immunochemotherapy in Advanced Renal Cell Carcinomas / 대한비뇨기과학회지

PURPOSE: Despite numerous trials no various immunochemotherapeutic agents, advanced renal cell carcinomas (RCC) remain highly resistant to treatment. We report the results of immunochemotherapy to evaluate its efficacy, and to investigate factors modulating responses to treatment. MATERIALS AND METHODS: In this retrospective analysis, 54 patients with advanced RCC, having received either interferon-alpha (IFN-alpha) monotherapy, or a combination of interleukin-2 (IL-2), 5-fluorouracil (5-FU) and vinblastine, with IFN-alpha between January 1999 and March 2001, were reviewed. The patients were divided into 2 groups, either single or combined, therapy groups, which were further subdivided into locally advanced and metastatic disease groups. The nephrectomy and performance stati, cancer stage at the beginning of the immunotherapy, metastasized organs and interval to metastasis, were considered, and the responses to treatment and survival were evaluated accordingly in each subgroup. RESULTS: Of the 54 patients, 39 received monotherapy, 34 of which had a metastatic disease. Partial remission was observed in 1 patient (2.9%) with a duration of response of 52 weeks, a median survival of 47 weeks (4-323 wks) and a 1 year survival rate of 41.2%. Of the 15 patients in the combined therapy group, 12 with a metastatic disease, complete remission was noted in 1 patient (8.3%), with a continuous response at 57 weeks, a median survival of 34 weeks (4-204 wks) and a 1 year survival rate 41.7%. Of the prognostic factors, the nephrectomy status proved to be the only significant factor improving survival. CONCLUSIONS: Advanced RCC exhibited a very limited response, and nephrectomy status was revealed to be the only significant factor affecting survival. The efficacy of immunotherapy on locally advanced RCC needs further controlled evaluative studies.