ObjectiveTo summarize the practice of UK urologists with regard to nephrectomy for benign disease, documenting the indications, procedural techniques and outcomes.
MethodsAll patients undergoing nephrectomy for a benign condition in 2012 were identified from the British Association of Urological Surgeons (BAUS) nephrectomy database. Recorded variables included the technique of surgery, the type of minimally invasive procedure, operating time, blood loss, transfusion rate, conversion rate, intra-and postoperative complications and mortality rate. Cases were also subanalysed according to their pathologies to determine the differences in complication rate between stone disease, pyelonephritis, non-functioning kidney and other benign lesions. To contextualize procedural complexity, the simple nephrectomy data were compared with those obtained from the BAUS stage T1 radical nephrectomy audit.
ResultsA total of 1 093 nephrectomies were performed (537 nonfunctioning kidneys, 142 stone disease, 129 nephrectomies secondary to pyelonephritis and 285 cases with other benign conditions). Of these, 76% were performed laparoscopically. Blood loss >500 mL was noted in 74 cases with a 4.8% blood transfusion rate. The intra-and postoperative complication rates were 5.2 and 11.9%, respectively. Of the 847 minimally invasive procedures, the conversion rate was 5.9%. Patients with stone disease have the highest intra-and postoperative complications (9.9 and 23.9%, respectively) compared with other benign pathologies. The total number of T1 radical nephrectomies performed was 1 095. In comparison with T1 radical nephrectomy, simple nephrectomy carries an increased risk of conversion to an open procedure (1.8 times), a higher rate of blood transfusion (4.8 vs 2.8%), and a higher risk of intra-and postoperative complications (5.2 vs 3.7% and 11.9 vs 10%, respectively).
ConclusionThe present study reports the largest series of nephrectomies performed for benign disease and the resultant data now support the bespoke preoperative counselling of patients. Furthermore, it confirms the commonly held view that simple nephrectomy can be more difficult than its radical counterpart. The authors suggest that the term 'simple nephrectomy' is changed to 'benign nephrectomy'.
RESULTSOf 373 men aged 50-79 years, 278 (75%) had their PSA level measured, and 50 were abnormal. Prostate biopsies were taken in 27 men with an abnormal PSA level (54%) and one man with a normal PSA level but an abnormal digital rectal examination. Prostate cancer was detected in 22 patients (8% of those tested, and 71% of those biopsied); 4.7% of all men presenting with macroscopic haematuria and aged 50-79 years were found to have prostate cancer, vs 8.5% of those with microscopic haematuria.
CONCLUSIONSWe report a higher proportion of prostate cancers in men presenting with haematuria and aged 50-79 years than reported in previous screening studies, and a cancer detection rate of 71% of those biopsied, which is at least double the detection rates seen in screening studies. In the absence of a prospective controlled trial, PSA testing will remain part of our protocol for both macroscopic and microscopic haematuria.
This audit suggests an effective use of the outpatient follow up resource with respect to the appropriateness and timing of follow up consultations. Other areas of resource management such as default rates should be investigated in an attempt to improve the efficiency of a service.
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