Urologist-Acquired Renal Access for Percutaneous Renal Surgery

Objectives. In most endourology programs an interventional radiologist is employed to acquire renal access for percutaneous renal surgery. Over the last 13 years the senior endourologist at Oregon Health Sciences University has acquired access without employing a radiologist. We report our experience with urologist-acquired renal access for percutaneous renal surgery in 522 cases.Methods. We reviewed the records of all patients at our hospital who underwent percutaneous renal surgery between August 1983 and December 1996 with renal access being obtained in the operating room by a urologist.Results. Four hundred fifty-six patients underwent 522 procedures. Indications for percutaneous renal surgery were renal and proximal ureteral calculi (n = 516), retained ureteral stent (n = 3), and intrarenal collecting system tumor (n = 3). We were successful in gaining access to 513 of 522 kidneys (98.3%). Access was obtained via a subcostal approach in 344 procedures, over the 12th rib in 152 procedures, over the 11th rib in 15 procedures, and transabdominally in 2 procedures. Sixty-five patients (12.7%) required a second or multiple sites to facilitate complete removal of calculi. Our overall complication rate was 15.3%. Blood transfusion was required in 5.4% of the cases, ileus developed in 1.9%, pneumothorax in 1.1%, intraoperative hydrothorax in 1.1%, postoperative pleural effusion requiring aspiration in 0.9%, and septic shock in 0.9%. Our overall success rate for stone removal was 94.5%.Conclusions. In our experience, the urologist is able to safely and effectively obtain percutaneous access to the collecting system for percutaneous renal surgery as a one-stage procedure without the aid of interventional radiologists.     

Renal Adenoma Associated with Renal Cyst Formation

We report a renal adenoma associated with renal cyst formation in a 49-year-old male. A small renal mass inside a right renal cyst was discovered incidentally by ultrasonography. A right nephrectomy was performed. A pathologic examination revealed a well-differentiated, benign papillary tumor which was composed of slightly eosinophilic cells. We therefore diagnosed this patient as having a renal adenoma with hemorrhage.     

Renal Imaging in Patients with Renal Impairment

In patients with renal impairment, the incremental benefits from administration of contrast media for imaging studies need to be carefully assessed relative to the potential increased risks of worsening renal dysfunction and systemic adverse effects. This review provides an overview of risk and benefits of iodinated and gadolinium-based contrast agents; examines their relationships to contrast-induced nephropathy (CIN) and nephrogenic systemic fibrosis (NSF), respectively; and discusses various clinical strategies to minimize the risk of CIN and NSF. Specifically, renal imaging strategies aimed to minimize the adverse effects of contrast media as well as alternatives to iodinated and gadolinium-based contrast-enhanced renal imaging are proposed with emphasis on non–contrast-enhanced magnetic resonance imaging.     

肾脓肿机化误诊为肾肿瘤

肾脓肿在其机化的晚期,就其影象学表现,不管是尿路造影、超声显象,或是在CT 扫描上,与肾实质肿瘤坏死的鉴别比较困难。     

Early Assessment of Renal Resistance Index and Long-Term Renal Function in Renal Transplant Recipients

Background. The effect of the intrarenal arterial resistance index (RI) on long-term renal functions is not well known. We examined the predictive value of intrarenal RI on long-term allograft outcomes. Methods. We retrospectively investigated 121 stable renal transplant recipients, followed for a mean of 63.21?±?19.9 months after renal transplant. Patients with complications during the first six months after transplant were not included. Color Doppler ultrasonography was done to calculate the intrarenal RI within the first four weeks after transplant. Results. Older recipient age, high pulse pressure, active smoking, and proteinuria were associated with a higher intrarenal RI. Multivariate analyses revealed that renal RI and donor age were independent predictors of allograft outcome. Kaplan-Meier estimates of cumulative graft survival were significantly worse in patients who had an RI of 0.7 or more than they were in patients who had an RI of less than 0.7 (p?=?.005). Development of chronic allograft nephropathy (CAN) was significantly higher in patients who had an RI of 0.7 or more (p?=?.02). Conclusions. Renal RI determined within the first month after renal transplant predicts long-term allograft function and development of CAN in renal transplant recipients.     

核素肾动态显像法测定肾小球滤过率在老年肾癌患者中的应用

目的：探讨核素肾动态显像法测定肾小球滤过率（GFR）在老年肾癌患者中的临床应用价值.方法：回顾性分析30例老年肾癌患者术前及术后1个月应用99锝-二乙三胺五乙酸（99TC-DTPA）肾动态显像法测定GFR的结果,对健侧肾及术侧残肾进行手术前后的比较,观察其代偿性变化.结果：肾根治性切除组术后健侧肾GFR为（57.6±11.8）ml/min,较术前健侧肾（41.2±7.4）ml/min增加39.8%,但与术前双肾GFR（74.9±12.8）ml/min比较则下降了23.1%.肾部分切除组术侧残肾GFR为（27.8±4.8）mI/min,较术前（36.5±6.4）ml/min减少23.9%,健侧肾GFR手术前后比较差异无统计学意义.结论：采用核素肾动态显像法测定GFR在评估老年肾癌患者分肾功能、选择手术方式及监测术后肾功能方面有重要临床价值.     

Obesity Affects Short-Term Renal Function After Renal Transplantation

BackgroundThe literature has shown a significant association between body mass index (BMI) and patient and graft outcomes after renal transplantation. The purpose of this study was to reveal the effect of obesity on graft function in a Taiwanese kidney transplant cohort.MethodsTwo hundred consecutive patients who received kidney transplantation were enrolled in our study. Eight pediatric cases were excluded due to differing definitions of BMI among children. According to the national obesity criteria, these patients were divided into underweight, normal, overweight, and obese groups. Their estimated glomerular filtration rate (eGFR) was compared accordingly using t tests. Cumulative graft and patient survivals were calculated using Kaplan-Meier analysis. A P value of ≤ .05 was considered significant.ResultsThe mean age of our cohort (105 men and 87 women) was 45.3 years. There was no significant difference comparing biopsy-proven acute rejection, acute tubular necrosis, and delayed graft function between the obese and nonobese groups (P values: .293, .787, and .304, respectively). Short-term eGFR was inferior in the overweight group, but this effect was insignificant beyond 1 month. The 1-month and 3-month eGFR were found to be correlated with BMI groups (P = .012 and P = .008, respectively) but not significant after 6 months post–kidney transplantation.ConclusionsOur study found that short-term renal function was affected by obesity and being overweight, possibly due to the higher prevalence of diabetes and dyslipidemia in obese patients and the increased surgical difficulty.     

肾损伤出血的超选择性肾动脉栓塞治疗

目的总结超选择性肾动脉栓塞在肾损伤出血治疗中的应用效果。方法2001年1月~2006年12月12例肾损伤血尿患者,肾结石肾积水行切开取石术后7例,肾穿刺活检术后2例;肾脏闭合性损伤2例,刀刺伤1例。行超选择性肾动脉栓塞术,以弹簧圈(5例)、PVA(6例)、丝线(1例)进行栓塞。结果术中证实12例均为肾段或肾段以下动脉损伤,术后所有病例新鲜出血立即停止,随访1~3个月,效果良好,未见有肾血管性高血压。结论肾损伤出血以超选择性插管栓塞为佳。     

Coexisting Renal Cell Carcinoma and Renal Artery Aneurysm

We report a rare case of a patient with a renal artery aneurysm (RAA) and an ipsilateral renal cell carcinoma (RCC). This patient was treated with simultaneous aneurysmectomy and radical nephrectomy. The indications for surgical intervention for RAA remain controversial. We present a review of the literature on the clinical presentation, classification, etiology, and management of RAA and associated RCC.     

原位低温阻断肾血管肾实质切开取石术

目的探讨原位低温阻断肾血管肾实质切开取石术治疗复杂性肾结石的效果。方法2000年3月～2005年1月采用原位低温阻断肾血管肾实质切开取石术治疗肾内型肾盂复杂性肾结石患者22例,术中快速静脉滴注肌苷2.0g,静滴20%甘露醇250ml。根据术前影像检查结果及术中所见选择肾切口径路:13例充填于各盏的鹿角状结石,行肾背侧Brodt线肾实质肾盏切开取石;5例肾下盏肾盂鹿角状结石,行肾盂肾实质联合切开取石;4例结石过多者,于肾皮质最薄处另作放射状切口取石。结果肾血管阻断时间平均45(30～60)min;手术时间平均110(90～180)min;平均失血量150(80～400)ml。结石一次取净21例,1例残余结石,术后2个月带双J管行ESWL碎石排出。术后1～2月复查肾功能,术前有肾功能损害的8例,血清Cr平均110.2μmol/L,血清BUN平均8.0mmol/L,均明显改善,其余患者肾功能无损害,无严重术后并发症。18例随访6个月～3年无一例复发。结论原位低温阻断肾血管肾实质切开取石术治疗复杂性肾结石安全有效、出血少、结石残留率低。