Higher RENAL Nephrometry Score is Predictive of Longer Warm Ischemia Time and Collecting System Entry During Laparoscopic and Robotic-assisted Partial Nephrectomy

Mayer, Wesley A.; Godoy, Guilherme; Choi, Jong-Woo; Goh, Alvin C.; Bian, Shelly X.; Link, Richard E.

doi:10.1016/j.urology.2012.01.048

Cited by 52 publications

(51 citation statements)

References 18 publications

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“…In the RENAL scoring system, the distance from the tumor to renal sinus or UCS is evaluated as 3 categorized ordinal variables, applying a cutoff of 4 and 7 mm, which is not based on sufficient evidence. Mayer et al reported that total RENAL score and nearness were predictive of intraoperative UCS entry in laparoscopic PN (LPN) and robot-assisted LPN series [13]. In this study, the distance from the tumor to renal sinus was measured on the images produced by MPR.…”

Section: Discussionmentioning

confidence: 99%

“…NSs are reported to be associated with the risk of urine leak after PN [11-13]. In the PADUA scoring system, a relation between the tumor and the UCS is simply categorized into a binary nominal variable as either not involved or infiltrated/dislocated, and the distance is not considered.…”

Section: Discussionmentioning

confidence: 99%

“…Several studies have reported on the relationship of these NSs with the risk of intraoperative UCS entry and urine leak after surgery [11-13]. However, these NSs are not designed for predicting intraoperative UCS entry, which could cause urine leak after surgery.…”

Section: Introductionmentioning

confidence: 99%

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Prediction of Intraoperative Urinary Collecting System Entry in Patients with Peripheral Renal Tumors Undergoing Partial Nephrectomy: Usefulness of Tumor-Centered Multiplanar Reconstruction

et al. 2017

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Objective: To assess the usefulness of tumor-centered multiplanar reconstruction (TC-MPR) for predicting intraoperative urinary collecting system (UCS) entry in patients with peripheral renal tumors undergoing partial nephrectomy (PN). Methods: Dynamic computed tomography images of 50 peripheral cT1 renal tumors treated with laparoendoscopic PN were analyzed. TC-MPR generated a digital cross-sectional image showing the tumor center and the closest calyx on a same plane. Patients and tumor characteristics including the distance from the tumor margin to the closest calyx (MPR-distance), and the angle formed by 2 tangent lines from the closest calyx to the tumor (MPR-angle) were assessed. Results: Intraoperative UCS entry was observed in 15 patients (30%). The patients who experienced intraoperative UCS entry had a higher RENAL score, wider MPR-angle, and shorter MPR-distance than those who did not (p = 0.04, p = 0.001, p < 0.001, respectively). Multivariate analysis identified MPR-angle as an independent factor for intraoperative UCS entry (p < 0.001). Conclusions: The spatial information assessed using TC-MPR serves as a predictive factor for intraoperative UCS entry during PN.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Prediction of Intraoperative Urinary Collecting System Entry in Patients with Peripheral Renal Tumors Undergoing Partial Nephrectomy: Usefulness of Tumor-Centered Multiplanar Reconstruction

et al. 2017

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“…Given the small number of events (31 leaks) and differences in complexity of the tumors between the RPN and LPN groups, it is difficult to reach a definite conclusion on this. However, it can be speculated that the better vision offered by robotic console and the articulation ability of robotic instruments facilitate better identification and repair of the breached collecting systems (25,26). This could be another explanation with regards to decrease utility of intraoperative ureteral catheter in the robotic cohort.…”

Section: Discussionmentioning

confidence: 99%

Urine leak in minimally invasive partial nephrectomy: analysis of risk factors and role of intraoperative ureteral catheterization

et al. 2014

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ARTICLE INFO ______________________________________________________________ ______________________Purpose: To investigate risk factors for urine leak in patients undergoing minimally invasive partial nephrectomy (MIPN) and to determine the role of intraoperative ureteral catheterization in preventing this postoperative complication. Materials and Methods: MIPN procedures done from September 1999 to July 2012 at our Center were reviewed from our IRB-approved database. Patient and tumor characteristics, operative techniques and outcomes were analyzed. Patients with evidence of urine leak were identified. Outcomes were compared between patients with preoperative ureteral catheterization (C-group) and those without (NC-group). Univariable and multivariable analyses were performed to identify factors predicting postoperative urine leak.Results: A total of 1,019 cases were included (452 robotic partial nephrectomy cases and 567 laparoscopic partial nephrectomy cases). Five hundred twenty eight patients (51.8%) were in the C-group, whereas 491 of them (48.2%) in the NC-group. Urine leak occurred in 31(3%) cases, 4.6% in the C-group and 1.4% in the NC-group (p<0.001). Tumors in NC-group had significantly higher RENAL score, shorter operative and warm ischemic times. On multivariable analysis, tumor proximity to collecting system (OR=9.2; p<0.01), surgeon's early operative experience (OR=7.8; p<0.01) and preoperative moderate to severe CKD (OR=3.1; p<0.01) significantly increased the odds of the occurrence of a postoperative urine leak. Conclusion: Clinically significant urine leak after MIPN in a high volume institution setting is uncommon. This event is more likely to occur in cases of renal masses that are close to the collecting system, in patients with preoperative CKD and when operating surgeon is still in the learning curve for the procedure. Our findings suggest that routine intraoperative ureteral catheterization during MIPN does not reduce the probability of postoperative urine leak. In addition, it adds to the overall operative time.

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“…relative to polar lines-was developed by Kutikov and Uzzo [4] as an objective scoring system to quantitatively evaluate anatomical features of a renal mass relevant to surgical decision making. To date, several studies have reported the usefulness of the RNS in predicting perioperative outcomes following PN [5][6][7][8][9][10][11]. For example, Long et al [5] conducted a retrospective review of data from 177 patients receiving PN and showed that an increased risk of conversion to radical nephrectomy and prolonged warm ischemia time (WIT) could be predicted by the RNS.…”

Section: Introductionmentioning

confidence: 99%

Significant impact of R.E.N.A.L. nephrometry score on changes in postoperative renal function early after robot-assisted partial nephrectomy

et al. 2014

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Higher RENAL Nephrometry Score is Predictive of Longer Warm Ischemia Time and Collecting System Entry During Laparoscopic and Robotic-assisted Partial Nephrectomy

Cited by 52 publications

References 18 publications

Prediction of Intraoperative Urinary Collecting System Entry in Patients with Peripheral Renal Tumors Undergoing Partial Nephrectomy: Usefulness of Tumor-Centered Multiplanar Reconstruction

Prediction of Intraoperative Urinary Collecting System Entry in Patients with Peripheral Renal Tumors Undergoing Partial Nephrectomy: Usefulness of Tumor-Centered Multiplanar Reconstruction

Urine leak in minimally invasive partial nephrectomy: analysis of risk factors and role of intraoperative ureteral catheterization

Significant impact of R.E.N.A.L. nephrometry score on changes in postoperative renal function early after robot-assisted partial nephrectomy

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