Search

Introduction: Multiple studies have concluded that ambulatory percutaneous nephrolithotomy (aPCNL) is safe. However, selection criteria remain vague and no investigators have assessed the practicality of using various post-procedural drainage strategies in the ambulatory setting. In this study we establish a set of inclusion and exclusion criteria for aPCNL, compare outcomes between aPCNL patients and those admitted following PCNL, and incorporate a variety of "exit" strategies including Double-J stent, ureteropelvic junction (UPJ) stent and totally tubeless techniques. Methods: We developed inclusion and exclusion criteria to determine patient eligibility for aPCNL. Between January 2014 and December 2016, 52 out of 145 patients met criteria for aPCNL and 47 of these patients were ultimately discharged on the same day. Forty-seven of the remaining 98 patients who were admitted following PCNL were randomly selected as a control group. Primary outcomes included stone-free status, emergency department (ED) visits and hospital readmissions within the 6-week post-operative period. Statistical analysis was performed using Student's t-tests, chi square tests, and Fischer's exact tests. Results: Both groups had similar age (P = 0.91), sex (P = 0.68), body mass index (P = 0.91), and stone burden (P = 0.12). Patients in the ambulatory group had a lower Charlson Comorbidity score (aPCNL CCS = 0.11, inpatient PCNL CCS = 0.62, P = 0.002). Seventy three percent of ambulatory patients and 62% of standard PCNL patients had no residual stone burden 6 weeks following PCNL (P = 0.33). The average residual stone fragment in our ambulatory and standard PCNL group was 3.5 and 3.2 mm, respectively. Five patients (11%) from the aPCNL group and 4 (9%) from the standard PCNL group presented to the ED (P = 0.76). One aPCNL (2%) and three standard PCNL (6%) patients were re-admitted to the hospital (P = 0.62). Conclusions: In this study we establish specific inclusion and exclusion criteria for aPCNL. Using these criteria we then demonstrated the practicality of using various exit strategies to facilitate aPCNL. Future randomized control trials would be beneficial in confirming the safety and efficacy of aPCNL in select patients. [ABSTRACT FROM AUTHOR]

Introduction: Being able to predict glomerular filtration rate (GFR) plateau after partial nephrectomy (Pnx) is an important goal in providing patients with a confident projection of maintained renal function. As such, in an ethnically and socioeconomically diverse, inner city cohort of patients undergoing Pnx, we compared preoperative (pre-op) and day of discharge (DC) GFR to that of long-term GFR measured at 12–18 months to evaluate postoperative (post-op) GFR stability. Methods: A total of 162 patients who had undergone minimally invasive Pnx at a single institution between 2010 and 2016 were reviewed. Patients with the following available measurements were included: pre-op GFR, DC GFR, and long-term GFR (12–18 months after DC). Multivariate linear regression was performed to assess factors predictive of long-term GFR, including estimated blood loss, warm ischemic time, tumor size, length of stay, pre-op GFR, DC GFR, race, chronic kidney disease, diabetes mellitus, and hypertension. Results: Mean pre-op GFR, DC GFR, and long-term GFR were 70.754, 68.326, and 66.526 mL/(minute ·1.73 m2), respectively. Mean GFR change was −4.228 pre-op to long term and −1.800 DC to long term. No significant difference was observed between means of DC GFR and long-term GFR (p = 0.248) as well as between means of pre-op GFR and DC GFR (p = 0.062). A significant difference was observed between pre-op GFR and long-term DC GFR (p = 0.002). On multivariate analysis, both pre-op GFR (β = 0.532; 95% confidence interval [CI] = 0.256–0.808; p ≤ 0.001) and DC GFR (β = 0.312; 95% CI = 0.089–0.537; p = 0.007) were found to be strong predictors of long-term GFR (R2 = 0.608). Conclusions: Long-term GFR in a highly ethnically diverse inner city population recovering from Pnx is stable relative to GFR measured at DC from the hospital. Our findings demonstrate that patients experience a GFR plateau after surgery, resulting in minimal change in renal function at a mean of 14 months post-op. [ABSTRACT FROM AUTHOR]

Introduction and Objectives: It is well known that adipose tissue plays a key role in the metabolic syndrome. We investigated whether visceral fat (VFA) and or subcutaneous fat (SQF) levels are associated with the tumor phenotype of small renal masses. Additionally, we sought to investigate the relationship between VFA and baseline renal function as measured by glomerular filtration rate. Materials and Methods: From 2002 through 2011, 144 patients undergoing minimally invasive partial nephrectomy were retrospectively reviewed by a radiologist for VFA and SQF fat measurements, using standard software. A third parameter, visceral adipose tissue percent (VAT%), was also calculated using the formula: (VAT%=[VFA/VFA+SQF]×100%). We used tertiles of VFA and SQF content to compare demographic and clinical characteristics. We also looked at VFA as a continuous variable. Associations between covariables were analyzed using multivariate logistic regression analysis and odds ratios with 95% confidence intervals. Results: Eighty-one patients had renal-cell carcinoma (RCC) and 30 patients had non-RCC pathology. On multivariate analysis, increasing BMI ( p=0.023), VFA ( p=0.048), VAT% ( p=0.028), and Charlson comorbidity score ( p=0.047) were significantly associated with worse preoperative Modification of Diet in Renal Disease (MDRD). In a subset multivariate analysis of the 81 patients with RCC, increasing VFA was statistically associated with worsening Fuhrman grade ( p=0.017). Conclusions: VFA may be linked to the pathophysiology of renal function in patients evaluated for renal masses. Additionally, VFA may be associated with worsening tumor grades in patients with small-volume RCC. Interestingly, SQF did not play such a role. This small study proposes an interesting physiologic link between VFA and the biology of both kidney function and tumor histology. Larger studies are needed to corroborate our findings. [ABSTRACT FROM AUTHOR]