Seshadri Sriprasad1, Mohammed Aldiwani1, Shiv Pandian1, Tommy K Nielsen2, Mohamed Ismail3,4, Neil J Barber5, Giovanni Lughezzani6, Alessandro Larcher6, Brunolf W Lagerveld7, Francis X Keeley3. 1. Department of Urology, Darent Valley Hospital, Dartford, United Kingdom. 2. Department of Urology, Aarhus University Hospital, Aarhus, Denmark. 3. Bristol Urological Institute, North Bristol NHS Trust, Bristol, United Kingdom. 4. Department of Urology, Portsmouth Hospitals NHS trust, Portsmouth, United Kingdom. 5. Department of Urology, Frimley Park Hospital, Camberley, United Kingdom. 6. Department of Urology, San Raffaele Hospital, Milan, Italy. 7. Department of Urology, Onze Lieve Vrouwe Gasthuis, Amsterdam, the Netherlands.
Abstract
Objectives: To estimate and quantify the loss of kidney function in solitary kidneys with small renal masses (SRMs) after laparoscopy-assisted renal cryoablation (LARC), from the European Registry for Renal Cryoablation (EuRECA) database. Patients and Methods: Of the 808 patients from eight European centers in the database, 102 patients had SRMs in solitary kidneys. Patient demographics, body mass index (BMI), American Society of Anesthesiologists (ASA) grade, Charlson comorbidity index, and tumor characteristics including nephrometry (PADUA) score where available were collected. Renal function data in the form of estimated glomerular filtration rate (eGFR) and chronic kidney disease (CKD) stratification both preoperatively and at 3 months postoperatively were collected. Results: The median (interquartile range [IQR]) age was 67 (59-81) years, the median (IQR) BMI was 26 (23.9-28.9) kg/m2, and the median (IQR) ASA score was 2 (2-3). The median Charlson score was 4 (range: 0-10). The median (IQR) tumor size in cross-sectional imaging was 26 (19-38) mm. The follow-up data were available for 72 patients with a median follow-up for this group of 38 (range: 10-132) months. The mean preoperative eGFR was 55.0 mL/minute/1.73 m2 (standard deviation [SD] = 18.1), and the mean postoperative eGFR was 51.8 mL/minute/1.73 m2 (SD = 18.8). The change was -3.1 mL/minute/1.73 m2 (95% confidence interval -5.2 to -1.0) units, which was statistically significant (p = 0.004). The change in the CKD stages comparing before and after LARC was not significant (paired two-tailed t-test, p = 0.06). Critically, the decrease in the eGFR did not translate to any significant adverse outcome and zero patients required dialysis. Conclusion: To the best of our knowledge, this is the largest study of renal function after LARC in SRMs in solitary kidneys. Cryotherapy in this imperative situation is safe, carries clinically insignificant reduction in renal function, therefore providing an option to minimize the risk of developing renal failure necessitating dialysis.
Objectives: To estimate and quantify the loss of kidney function in solitary kidneys with small renal masses (SRMs) after laparoscopy-assisted renal cryoablation (LARC), from the European Registry for Renal Cryoablation (EuRECA) database. Patients and Methods: Of the 808 patients from eight European centers in the database, 102 patients had SRMs in solitary kidneys. Patient demographics, body mass index (BMI), American Society of Anesthesiologists (ASA) grade, Charlson comorbidity index, and tumor characteristics including nephrometry (PADUA) score where available were collected. Renal function data in the form of estimated glomerular filtration rate (eGFR) and chronic kidney disease (CKD) stratification both preoperatively and at 3 months postoperatively were collected. Results: The median (interquartile range [IQR]) age was 67 (59-81) years, the median (IQR) BMI was 26 (23.9-28.9) kg/m2, and the median (IQR) ASA score was 2 (2-3). The median Charlson score was 4 (range: 0-10). The median (IQR) tumor size in cross-sectional imaging was 26 (19-38) mm. The follow-up data were available for 72 patients with a median follow-up for this group of 38 (range: 10-132) months. The mean preoperative eGFR was 55.0 mL/minute/1.73 m2 (standard deviation [SD] = 18.1), and the mean postoperative eGFR was 51.8 mL/minute/1.73 m2 (SD = 18.8). The change was -3.1 mL/minute/1.73 m2 (95% confidence interval -5.2 to -1.0) units, which was statistically significant (p = 0.004). The change in the CKD stages comparing before and after LARC was not significant (paired two-tailed t-test, p = 0.06). Critically, the decrease in the eGFR did not translate to any significant adverse outcome and zero patients required dialysis. Conclusion: To the best of our knowledge, this is the largest study of renal function after LARC in SRMs in solitary kidneys. Cryotherapy in this imperative situation is safe, carries clinically insignificant reduction in renal function, therefore providing an option to minimize the risk of developing renal failure necessitating dialysis.
Authors: Michaël M E L Henderickx; Annebeth E C Sträter-Ruiter; Alwine E van der West; Harrie P Beerlage; Patricia J Zondervan; Brunolf W Lagerveld Journal: Arab J Urol Date: 2020-12-17
Authors: Andrea Piasentin; Francesco Claps; Tommaso Silvestri; Giacomo Rebez; Fabio Traunero; Maria Carmen Mir; Michele Rizzo; Antonio Celia; Calogero Cicero; Martina Urbani; Luca Balestreri; Lisa Pola; Fulvio Laganà; Stefano Cernic; Maria Assunta Cova; Michele Bertolotto; Carlo Trombetta; Giovanni Liguori; Nicola Pavan Journal: Medicina (Kaunas) Date: 2022-08-03 Impact factor: 2.948