Nephrectomy indications in kidney diseases: 10-years’ experience study

Abstract

Background. Nephrectomy, a performance surgery in urology practice, may lead to an irreversibly kidney injuries during surgical removal. This study aims to describe 10-years of experience with nephrectomy, its indications and complications in kidney diseases. Materials and methods. Data for all the patients who underwent nephrectomy were collected including demographics, age, sex, education, smoking, alcohol consumption, aetiology, past medical and surgical history and comorbidity. Indications for nephrectomy were stones, obstruction, tumors, pyelonephritis and autosomal dominant polycystic kidney disease. Among complications, thrombocytopenia, fever, hyperkalemia, hypertension, ileus, pneumonia, pneumothorax, septic shock, surgical site infection, hyperglycemia, bleeding and postoperative nausea and vomiting were recorded. Preoperative preparation included laboratory tests such as complete blood count, renal function test and liver function test. It is reasonable to perform renoscintography before nephrectomy to consider partial nephrectomy. However, in our study we performed it routinely because nearly all patients underwent ultrasonography or/and computed tomography scan of abdomen/pelvis to detect pathologies. A percutaneous polyurethane catheters or stents were placed. A guidewire was inserted into the kidney via the rigid cystoscope. Results. A total of 50 nephrectomies were performed. The median age of patients was 45 years ranging from 14 to 73 years. About 60 % of the patients were females and 40 % were males. Patients were educated (48 %), smoking (56 %), alcoholic (12 %), with past medical and surgical history (50 %), comorbidities (46 %) and lived in rural region (44 %) and urban areas (56 %). Stones and obstruction accounted for the majority of cases, 52 and 36 %, respectively. Most of the nephrectomies were performed with laparoscopic approach (58 %). Open surgery was done in 15 cases (30 %) because of adhesions and emphysema. Complications related to laparoscopy and open surgery occurred in 17 (34 %) of patients. Thrombocytopenia, fever, hyperkalemia, hypertension, ileus, pneumonia, pneumothorax, septic shock, surgical site infection, hyperglycemia, bleeding and postoperative nausea and vomiting were recorded. Conclusions. Stone disease and obstruction were the most common benign conditions requiring nephrectomy. The laparoscopic approach can be feasible for most benign kidney diseases requiring nephrectomies with adequate expertise. Сomplication rate in it is comparable with that of open surgery.