Matthias Maruschke1, Katja Hagel2, Oliver Hakenberg3, Thomas Scheeren4. 1. Department of Urology, Helios Hanseklinikum Stralsund, Große Parower Str. 47-53, 18435, Stralsund, Germany. matthias.maruschke@helios-kliniken.de. 2. Department of Internal Medicine, Filder Klinik, Filderstadt, Germany. 3. Department of Urology, University Hospital Rostock, Rostock, Germany. 4. Department of Anesthesiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
Abstract
BACKGROUND: Partial nephrectomy (PNx) can be associated with macrocirculatory and microcirculatory alterations, ultimately leading to acute kidney injury (AKI). Measuring kidney tissue oxygenation (μHbO2) and microcirculation during open PNx might be feasible to early detect these alterations and prevent postoperative AKI. METHODS: μHbO2 and microcirculation were measured in 45 patients undergoing PNx by reflectance spectrophotometry and laser Doppler flowmetry (O2C™, Lea, Germany), related to ischemia time and tumour size. Pre- and postoperative creatinine levels were determined. RESULTS: μHbO2 was lower after reperfusion than before clamping (72 vs. 75%), while microcirculation and regional haemoglobin did not differ. Ischemia time was 15.7 min on average. μHbO2 was higher without ischemia (80 vs. 70%, p = 0.109) and in T1a- than T1b-tumours, independent of ischemia time and reperfusion. The renal collecting system (RCS) was opened in 19/45 patients with μHbO2 of 68% after reperfusion compared to 74% with intact RCS. Postoperative complications occurred in 6/45 patients (13%). μHbO2 was 68% before clamping vs. 75% without complications. Serum creatinine of patients with T1b was higher compared to T1a (103 vs. 87 µmol/L). Patients with larger tumours had higher postoperative creatinine levels (173 vs. 124 µmol/L; p = 0.052). CONCLUSION: We showed for the first time that the method is feasible to monitor renal tissue oxygenation at the level of microcirculation non-invasively and reproducibly during PNx. Tumour size seems to have a decisive influence on oxygenation and postoperative renal function. Our results imply that postoperative complications may be predicted by low intraoperative renal oxygenation and microcirculatory flow measurements.
BACKGROUND: Partial nephrectomy (PNx) can be associated with macrocirculatory and microcirculatory alterations, ultimately leading to acute kidney injury (AKI). Measuring kidney tissue oxygenation (μHbO2) and microcirculation during open PNx might be feasible to early detect these alterations and prevent postoperative AKI. METHODS: μHbO2 and microcirculation were measured in 45 patients undergoing PNx by reflectance spectrophotometry and laser Doppler flowmetry (O2C™, Lea, Germany), related to ischemia time and tumour size. Pre- and postoperative creatinine levels were determined. RESULTS: μHbO2 was lower after reperfusion than before clamping (72 vs. 75%), while microcirculation and regional haemoglobin did not differ. Ischemia time was 15.7 min on average. μHbO2 was higher without ischemia (80 vs. 70%, p = 0.109) and in T1a- than T1b-tumours, independent of ischemia time and reperfusion. The renal collecting system (RCS) was opened in 19/45 patients with μHbO2 of 68% after reperfusion compared to 74% with intact RCS. Postoperative complications occurred in 6/45 patients (13%). μHbO2 was 68% before clamping vs. 75% without complications. Serum creatinine of patients with T1b was higher compared to T1a (103 vs. 87 µmol/L). Patients with larger tumours had higher postoperative creatinine levels (173 vs. 124 µmol/L; p = 0.052). CONCLUSION: We showed for the first time that the method is feasible to monitor renal tissue oxygenation at the level of microcirculation non-invasively and reproducibly during PNx. Tumour size seems to have a decisive influence on oxygenation and postoperative renal function. Our results imply that postoperative complications may be predicted by low intraoperative renal oxygenation and microcirculatory flow measurements.
Authors: Hendrik Van Poppel; Luigi Da Pozzo; Walter Albrecht; Vsevolod Matveev; Aldo Bono; Andrzej Borkowski; Marc Colombel; Laurence Klotz; Eila Skinner; Thomas Keane; Sandrine Marreaud; Sandra Collette; Richard Sylvester Journal: Eur Urol Date: 2010-12-22 Impact factor: 20.096
Authors: Nicholas M Donin; Lara K Suh; LaMont Barlow; Gregory W Hruby; Jeffrey Newhouse; James McKiernan Journal: BJU Int Date: 2011-08-18 Impact factor: 5.588
Authors: Jens Hansen; Maxine Sun; Marco Bianchi; Michael Rink; Zhe Tian; Nawar Hanna; Malek Meskawi; Jan Schmitges; Shahrokh F Shariat; Felix K-H Chun; Paul Perrotte; Markus Graefen; Pierre I Karakiewicz Journal: Urology Date: 2012-06-13 Impact factor: 2.649
Authors: Borje Ljungberg; Karim Bensalah; Steven Canfield; Saeed Dabestani; Fabian Hofmann; Milan Hora; Markus A Kuczyk; Thomas Lam; Lorenzo Marconi; Axel S Merseburger; Peter Mulders; Thomas Powles; Michael Staehler; Alessandro Volpe; Axel Bex Journal: Eur Urol Date: 2015-01-21 Impact factor: 20.096
Authors: Clemens Rosenbaum; Sven Wach; Frank Kunath; Bernd Wullich; Thomas Scholbach; Dirk G Engehausen Journal: Urol Int Date: 2012-11-13 Impact factor: 2.089
Authors: Ming Yin; Robert T Currin; Xing-Xi Peng; Harold E Mekeel; Robert Schoonhoven; John J Lemasters Journal: Ren Fail Date: 2002-03 Impact factor: 2.606
Authors: Ruth Ladurner; Maximilian Feilitzsch; Wolfgang Steurer; Stephan Coerper; Alfred Königsrainer; Stefan Beckert Journal: Microvasc Res Date: 2009-02-07 Impact factor: 3.514