Wilms' tumor
Mark Davenport, James D. Geiger, Nigel J. Hall, Steven S. Rothenberg in Operative Pediatric Surgery, 2020
Partial nephrectomy or “nephron-sparing” surgery (NSS) can be achieved in some children. The ideal candidates have single, favorable histology masses, not involving the renal hilum and sparing at least a third of the kidney and no metastatic disease. Surgery is initiated in a similar fashion to conventional nephrectomy. After opening Gerota's fascia and freeing the kidney from the perirenal fat, the tumor can be assessed (Figure 59.11). Intraoperative US can be beneficial for determining tumor depth and parenchymal extension and finding unrecognized intrarenal tumors. Biopsies are then taken of perirenal fat and regional lymph nodes for frozen section to establish staging. Finally, the affected kidney is walled off from the peritoneum with laparotomy sponges in case of inadvertent tumor spillage.
Urological Trauma
Manit Arya, Taimur T. Shah, Jas S. Kalsi, Herman S. Fernando, Iqbal S. Shergill, Asif Muneer, Hashim U. Ahmed in MCQs for the FRCS(Urol) and Postgraduate Urology Examinations, 2020
An 18-year-old male is brought in to the Emergency department after being stabbed in the right loin. There is no further history available. The patient’s blood pressure is poorly maintained with intravenous fluids but stabilises with a 2 unit blood transfusion. Contrast CT shows a Grade 4 Right renal injury. There is no suspected intra-abdominal injury. What is the next step in management?Request angioembolisation by experienced interventional radiologistUrgent insertion of JJ stentUrgent percutaneous drainage of peri-renal areaAdmit for bed rest, regular observations and follow-up bloods.Urgent exploratory laparotomy and kidney repair or nephrectomy
Urology
Gozie Offiah, Arnold Hill in RCSI Handbook of Clinical Surgery for Finals, 2019
Treatment➣ Partial or radical nephrectomy if the tumour is confined to the kidney. Clamp time crucial in preservation of renal function in partial nephrectomy/metastectomy.➣ Partial or radical nephrectomy via open, laparoscopic or robotic approach.➣ Responds poorly to radiotherapy or conventional chemotherapy.➣ Partial response rates of 15-20% can be achieved with immune modulators such as interferon, interleukin, tyrosine kinase inhibitors and checkpoint inhibitors such as nivolumab in palliative patients with good performance status.
The safety and efficacy of laparoscopic microwave ablation-assisted partial nephrectomy: a new avenue for the treatment of cystic renal tumors
Published in International Journal of Hyperthermia, 2023
Baoan Hong, Qiang Zhao, Yongpeng Ji, Yong Yang, Ning Zhang
According to current guidelines, partial nephrectomy remains the standard treatment for localized small renal tumors, intending to preserve kidney function and provide longer term tumor control [6]. Some theoretical questions regarding treating cystic renal tumors remain unanswered, especially concerns about cyst rupture and tumor implantation during surgery. Firstly, patients with renal cysts on preoperative imaging, receiving renal cyst unroofing, may be diagnosed as cystic renal cell carcinoma by postoperative pathology. Second, for patients with a high suspicion of cystic renal cell carcinoma, cyst rupture may occur during nephron-sparing surgery, and this carries the risk of tumor implantation and metastasis. The rate of cyst rupture during partial nephrectomy has been reported to be 20% [7,8].
Pragmatic Aspects of Controlled Donation after Circulatory Death and Ethical Considerations for Alternative Approaches
Published in The American Journal of Bioethics, 2023
In 2012, I proposed a strategy for kidney recovery prior to death in patients with severe neurological injury and no chance for survival, whose family had agreed to comfort measures and end-of-life care (Morrissey 2012). The procedure, a variation on current DCD protocols, begins with a patient suitable for DCD. However, applying the DDR as outlined by Nielsen Busch and Mjaaland, surgical removal of the kidneys precedes a death declaration, but does not cause the donor’s death. In the United States in 2021, over four thousand individuals donated organs after DCD. Why then should we consider a change? With astonishing frequency, no transplantable organs are recovered after DCD. Thirty percent of the time DCD candidates do not die soon enough for their organs to be transplanted, so none are recovered. Twenty percent of the kidneys removed are not transplanted, often because the extent of damage incurred while dying (respiratory arrest, hypoxia, low blood pressure, inadequate organ perfusion) makes transplantation too risky. Nephrectomy in a controlled operative setting could provide transplantable kidneys nearly 100% of the time which is akin to living kidney donation by healthy donors.
Shrunken pore syndrome in childhood cancer survivors treated with potentially nephrotoxic therapy
Published in Scandinavian Journal of Clinical and Laboratory Investigation, 2022
Esmee C. M. Kooijmans, Helena J. H. van der Pal, Maxime C. F. Pilon, Saskia M. F. Pluijm, Margriet van der Heiden-van der Loo, Leontien C. M. Kremer, Dorine Bresters, Eline van Dulmen-den Broeder, Marry M. van den Heuvel-Eibrink, Jacqueline J. Loonen, Marloes Louwerens, Sebastian J. C. Neggers, Hanneke M. van Santen, Wim J. E. Tissing, Andrica C. H. de Vries, Gertjan J. L. Kaspers, Margreet A. Veening, Arend Bökenkamp
The Dutch Childhood Cancer Survivor Study (DCCSS) LATER cohort (1963–2001) part 2; clinical visit and questionnaire study is a nationwide cross-sectional cohort study. Inclusion criteria were survivorship of childhood cancer ≥ 5 years after diagnosis and treatment in one of the Dutch seven pediatric oncology centers between 1963 and 2001 from 0 to 17 years old. Additional selection criteria for the current sub-study were as follows: (1) age ≥ 18 years at the time of study, (2) sufficient understanding of the Dutch language to provide informed consent, and (3) exposure to potentially nephrotoxic therapy – that is, (a) nephrectomy (unilateral, partial bilateral), (b) radiotherapy involving one or both kidneys in the field (abdominal, total body irradiation (TBI), in nephrectomized patients radiotherapy in the field of the remnant kidney), (c) chemotherapy; cisplatin, carboplatin, ifosfamide or high-dose (HD)-cyclophosphamide ≥ 1 g/m2 per single dose or ≥ 10 g/m2 in total, or (d) allogeneic hematopoietic stem cell transplantation (HSCT). For HD-cyclophosphamide, information regarding a single dose was incomplete. If cumulative cyclophosphamide dose was <10 g/m2, CCS were only selected if they had been treated according to ALL7 & ALL8 protocol [24,25]. In these protocols, the high single doses were well documented and traceable. Furthermore, CCS with a history of kidney transplantation or pregnancy at the time of study visit were excluded from the study cohort.
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