Transperitoneal laparoscopic renal denervation for the management of loin pain haematuria syndrome

Kadi, Nourdin; Mains, Edward; Townell, N. H.; Nabi, Ghulam

doi:10.3109/13645706.2013.789059

Cited by 9 publications

(6 citation statements)

References 19 publications

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“…Finally, although LNA was performed successfully for pain in 1 patient, other treatment options may offer renal denervation without autotransplantation. 18 …”

Section: Discussionmentioning

confidence: 99%

Laparoscopic Nephrectomy with Autotransplantation: Safety, Efficacy and Long-Term Durability

et al. 2015

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Purpose Laparoscopic nephrectomy with autotransplantation is a viable option when renal preservation is required or ureteral reconstruction is impossible. In this study we report on our long-term experience with laparoscopic nephrectomy with autotransplantation. Materials and Methods A retrospective review of data from all patients who underwent laparoscopic nephrectomy with autotransplantation since 2000 revealed data for 52 of 59 patients after study exclusions. Indications for laparoscopic nephrectomy with autotransplantation included ureteral stricture disease (41), renal malignancy (7), ptotic kidney (1), chronic flank pain (1), renal artery aneurysm (1) and renovascular hypertension (1). Followup included ultrasonography, nuclear renography and computerized tomography. Complications analyzed were Clavien-Dindo grade III or higher. Results A total of 52 patients (30 women, 57.6%) underwent laparoscopic nephrectomy with autotransplantation at a median age of 48 years (range 12 to 76). At a median followup of 73.5 months 47 patients (90.3%) had long-term function of the autotransplanted renal unit including 3 of 4 (75%) solitary kidneys. There were 5 patients (9.7%) who experienced renal unit failure at a median of 15 months. Of these patients 3 required nephrectomy of autotransplant unit secondary to renal vein thrombosis (1 day), pseudoaneurysm (15 months) and chronic pain (48 months). Overall 4 patients had early complications and 8 had late complications. In the tumor group 4 patients had disease progression and all are alive. Conclusions Laparoscopic nephrectomy with autotransplantation is an excellent long-term surgical option (greater than 90% success rate with longer than 6-year median followup) for complex ureteral and renal conditions that necessitate preservation of renal parenchyma. However, tumor progression is possible after ex vivo tumor excision. Therefore, careful patient selection and followup are mandatory. This report supports the safety, efficacy and durability of laparoscopic nephrectomy with autotransplantation in experienced hands.

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“…Finally, although LNA was performed successfully for pain in 1 patient, other treatment options may offer renal denervation without autotransplantation. 18 …”

Section: Discussionmentioning

confidence: 99%

Laparoscopic Nephrectomy with Autotransplantation: Safety, Efficacy and Long-Term Durability

et al. 2015

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“…A further 22% had decreased analgesic requirement. 17 Sheil et al. showed that 8 of 22 patients (36%) who underwent radical neurectomy were pain free (mean follow-up, 8.0 years), 18 in contrast to 29 of 35 patients (86%) who underwent renal autotransplantation, who were pain free and narcotic free (mean follow-up, 8.4 years).…”

Section: Discussionmentioning

confidence: 99%

Successful Use of Renal Denervation in Patients With Loin Pain Hematuria Syndrome—The Regina Loin Pain Hematuria Syndrome Study

Prasad

Giebel

Garcı́a

et al. 2018

Kidney International Reports

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IntroductionLoin pain hematuria syndrome (LPHS) is characterized by severe unilateral or bilateral loin pain that suggests a renal origin but occurs in the absence of identifiable or relevant urinary tract disease. Hematuria can either be microscopic or macroscopic, but the renal abnormalities responsible for the hematuria are unexplained. Debilitating pain refractory to conventional pain medications is the main cause of morbidity.MethodsWe conducted a single-arm, single-center study. Twelve patients between the ages of 21 and 62 years (11 female, 1 male) with LPHS underwent endovascular ablation of the renal nerves between July 2015 and November 2016, using the Vessix renal denervation system. The primary objective was to achieve 30% reduction in self-reported pain with the McGill Pain Questionnaire (MPQ) at 6 months. The secondary objectives were to measure changes in disability (Oswestry Disability Index [ODI]), mood (Geriatric Depression Scale [GDS]), and quality of life (EuroQol-5D [EQ-5D] and the MOS 36-Item Short Form Survey [SF-36]) scores from baseline to 6 months postprocedure.ResultsTen of 12 patients at 3 months and 11 of 12 patients at 6 months reported a >30% reduction in pain based on the MPQ at 3 and 6 months. We found consistent improvements in MPQ, ODI, GDS, EQ-5D, and SF-36 scores from baseline to 6 months postprocedure.ConclusionWe conclude that renal denervation is associated with a considerable improvement in pain, disability, quality of life, and mood. Our results suggest that percutaneous catheter−based delivery of radiofrequency energy is a safe, rapid treatment option that should be considered in all patients with LPHS.

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“… 4 Contemporary studies comprising chronic loin pain attributed to kidney affections other than ADPKD continues to exhibit poor outcomes, with the highest success rate of 44%. 5 Thus, the question to be made is how to improve renal denervation outcomes.…”

Section: Discussionmentioning

confidence: 99%

Laparoscopic Kidney Denervation for Refractory Loin Pain: Can We Predict Outcomes?

Srougi

Duarte

Srougi

et al. 2016

Urology Case Reports

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A 19-year-old female patient presented refractory disabling loin pain associated with mild kidney atrophy (split renal function of 33%). Investigation revealed elevated serum renin level; a therapeutic test with oral renin inhibitor was tried, obtaining important pain control. Aiming to resolve the symptom while preserving the patient kidney and attributing the pain mechanism to be associated with the abnormal renin production, a laparoscopic kidney denervation was performed with no complications and complete pain resolution.

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Transperitoneal laparoscopic renal denervation for the management of loin pain haematuria syndrome

Abstract: Laparoscopic renal denervation is a feasible and safe alternative to open procedures in patients with refractory LPHS, producing good outcomes in terms of pain-free rates and quality of life impact.

Cited by 9 publications

References 19 publications

Laparoscopic Nephrectomy with Autotransplantation: Safety, Efficacy and Long-Term Durability

Laparoscopic Nephrectomy with Autotransplantation: Safety, Efficacy and Long-Term Durability

Successful Use of Renal Denervation in Patients With Loin Pain Hematuria Syndrome—The Regina Loin Pain Hematuria Syndrome Study

Laparoscopic Kidney Denervation for Refractory Loin Pain: Can We Predict Outcomes?

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