Renal cell carcinoma with tumor thrombus in the lower cava vein reaching the right atrium - Case report and brief review of the literature.

Approximately 15% of cases of renal cell carcinoma (RCC) can invade the inferior vena cava, leading to the formation of a thrombus inside it, which can reach the cardiac chambers in up to 1% of cases. This article reports a case of RCC with venous thrombus that reached the right atrium. The patient underwent radical nephrectomy with lymphadenectomy and tumor thrombectomy with extracorporeal circulation associated with hypothermia, without total cardiac arrest. The surgical success of this case highlights the need to study new techniques that represent better operative approaches for solid kidney injuries.

Bladder function evaluation before renal transplantation in nonurologic disease: is it necessary?

OBJECTIVE: To determine whether preoperative cystometry and a pressure flow study (PFS) are necessary in patients with end-stage renal disease from nonurologic causes who will undergo renal transplantation. METHODS: From April 2009 to June 2010, 30 patients scheduled to undergo renal transplantation were prospectively evaluated with cystometry and PFS. The evaluation was performed immediately before and 6 months after renal transplantation. The inclusion criteria were age >18 years and end-stage renal disease secondary to nonurologic disease. RESULTS: Improvement in the cystometry and PFS parameters was observed after the return of diuresis at 6 months after transplantation. The parameter changes from baseline to the 6-month evaluation were as follows: first sensation of bladder filling, 88.8-168.7 mL (P = .0005); first desire to void, 137.2-251.1 mL (P <.0001); maximal cystometric capacity, 221.2-428.7 mL (P <.0001); bladder compliance, 73.9-138.6 mL/cm H2O (P = .03); and maximal flow rate, 8.1-15.8 mL/s (P <.0001). The Abrams-Griffiths number in the men decreased from 31.8 to 15.2 (P = .002). No significant changes were observed in the detrusor pressure at the maximal flow rate or the postvoid residual urine volume. Patients with a 24-hour urine output <200 mL tended to have had significantly worse parameters before transplantation. CONCLUSION: Significant improvement in the cystometry and PFS parameters was observed in patients with end-stage renal disease, without urologic disease, 6 months after transplantation, and was associated with recovery of the glomerular filtration rate and urine output by the renal graft.