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ObjectiveThe aim of this study is to evaluate a potential successful strategy for treating large renal hilar angiomyolipoma (RHAML) during the procedure of laparoscopic nephron-sparing surgery (NSS).MethodsThe total study population includes 12 patients with large RHAMLs who underwent laparoscopic NSS in the Department of Urology of Fujian Provincial hospital and People’s Hospital of Zhejiang, ranging from January 2016 to March 2020. The perioperative variables, intraoperative procedures, and postprocedure complications were all recorded. Three months later, all patients returned to the hospital to check their postoperative recovery by reviewing the computed tomography urography (CTU) image. In the follow-up, patients were asked to have their review by CT or color doppler ultrasound every year.ResultsLaparoscopic NSS was successfully performed in all patients. The average operation time was 113.33 ± 33.39 min; the intraoperative blood loss was about 137.50 ± 91.17 ml; the warm ischemia time was 25.25 ± 4.88 min; the drainage tube extubation time was 4.58 ± 2.07 days; and the hospital stay time was 6.42 ± 1.78 days. The average follow-up time was 14.58 ± 9.18 months. After 3 months, all CTU images showed an unobstructed urinary tract in the patient, and no tumor recurrence was found. In addition, no patients had renal atrophy and urine extravasation during follow-up.ConclusionsLaparoscopic NSS for RHAML is complex and technically demanding, but good surgical design and operation can achieve satisfactory surgical results. Modified laparoscopic NSS was a beneficial technique and may provide a reference for treating patients with RHAML.

To compare the applicability of 14 equations of estimating glomerular filtration rate (eGFR) before and after nephron-sparing surgery (NSS) for renal function assessment of patients with renal tumors. Preoperative and postoperative GFR is measured by emission computed tomography (ECT) with 99mTc-DTPA as an imaging agent as reference GFR (rGFR) to compare with all formulas. Spearman correlation analysis and Bland–Altman agreement analysis were used to evaluate the correlation between rGFR and eGFR1 to 14 before and after surgery. A total of 50 cases including 22 males and 28 females were included. The results of preoperative eGFR1–14 correlated with rGFR ( P < 0.05 ). The calculation results of all estimation formulas have a significant correlation with preoperative GFR. Preoperative MDRD-I, CKD-EPI SCysC, and FAS Scr-SCysC have good consistency. The CG formula has the highest precision and FAS Scr-SCysC has the highest accuracy. A total of 30 patients followed up after surgery, and postoperative rGFR correlated with CG, CKD-EPI, FAS, and BIS formulas ( P < 0.05 ). But postoperative rGFR has no significant correlation with MDRD and Schwartz ( P > 0.05 ). Postoperative CKD-EPI Scr-SCysC has best consistency, and FAS Scr-SCysC has the highest accuracy and precision. Our data suggest that eGFR equations evaluated by both serum creatinine (Scr) and cystatin C (SCysC) is not necessarily better than those evaluated by one of them alone. Among all enrolled equations, FAS Scr-SCysC is the best one to evaluate postoperative GFR in patients with renal tumors.