Sodium Fluorescein for Identification of Intraoperative Urine Leaks During Partial Nephrectomy

Kunitsky, Kevin; Lec, Patrick M; Brisbane, Wayne; Chamie, Karim

doi:10.1016/j.urology.2020.04.084

Cited by 3 publications

(1 citation statement)

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“…Для интраоперационной диагностики травмы ЧЛС во время ПН и ее адекватного закрытия K. Kunitsky и соавт. предлагают использовать флуоресцеин [30]. После резекции опухоли и снятия сосудистого зажима, а при безышемической ПН сразу, 5 мл препарата вводится внутривенно, за счет быстрой экскреции с мочой устанавливается поврежденная чашка, которая ушивается.…”

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Retrograde endoscopic assisted percutaneous treatment of urinary fistulas after partial nephrectomy

et al. 2021

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Background. Urinary fistulas (UFs) are one of the most significant complications after partial nephrectomy. Placement of an ureteral stent eliminates urine extravasation in the majority of patients. However, some of them have persistent UFs despite upper urinary tract drainage. Such cases require retrograde injection of fibrin glue into the renal cavity through a ureteroscope or via the percutaneous approach. Some authors reported cases of simultaneous use of 2 stents and percutaneous cryoablation of the fistula, but these techniques are rare and, therefore, it is problematic to evaluate their efficacy.Objective: to evaluate the results of the new treatment method for the elimination of persistent UFs using the retrograde endoscopic percutaneous approach.Materials and methods. This study included 5 patients (3 males and 3 females) with UFs developed after kidney resection. Mean age of the patients was 55.8 years. The tumor size was 2.5 to 4.8 cm; mean R.E.N.A.L. score was 7.8. All patients had earlier undergone minimally invasive partial nephrectomy; the time between surgery and UF development varied between 3 and 10 days. Four out of 5 patients had a large amount of discharge from their paranephral drainage system, examination of which confirmed high creatinine level. Patients underwent flexible ureteropyelography in the lithotomy position. During this procedure, we identified the damaged calyx and then performed percutaneous puncture targeting the distal end of the endoscope at this calyx, ensuring that the tip of the needle appeared in the paranephral cavity in front of the injured calyx. Using the flexible ureteroscope, we inserted the needle into the pelvis, dilated the puncture opening along the string, and installed a nephrostomy drainage system (12 Fr). Then the endoscope was removed and the ureter was additionally drained with a stent. The stent was removed after 8-10 days with subsequent antegrade pyelography. If there was no extravasation, the nephrostomy tube was removed and the patient was discharged from hospital to continue treatment in outpatient settings.Results. All patients with UFs resulting from partial nephrectomy was successfully operated on. No complications were registered. The mean surgery time was 45.0 ± 20.5 min (range: 40-65 min). Only two patients had some discharge from the fistula within 1 day after nephrostomy tube removal and it stopped without any additional interventions. Three patients had their fistula healed immediately. The treatment efficacy during the whole follow-up period of 18 ± 4 months (range: 6-26 months) was 100 %.Conclusion. Ureteral stenting ensures elimination of UFs in the majority of patients after partial nephrectomy. In individuals with persistent UFs, retrograde endoscopic percutaneous drainage of the pelvicalyceal system is the method of choice, because it allows rapid and effective treatment of UFs.

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Section: Discussionunclassified

Retrograde endoscopic assisted percutaneous treatment of urinary fistulas after partial nephrectomy

et al. 2021

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Re: Rui Farinha, Giuseppe Rosiello, Artur De Oliveira Paludo, et al. Selective Suturing or Sutureless Technique in Robot-assisted Partial Nephrectomy: Results from a Propensity-score Matched Analysis. Eur Urol Focus. In press. https://doi.org/10.1016/j.euf.2021.03.019

Grivas

Poel

2022

European Urology Focus

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Urinary fistulas after partial nephrectomy in renal cell carcinoma

Гулиев¹

2021

Vestn. urol.

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Urinary fistulas after partial nephrectomy are rare complications of this operation. There are various reasons for their development, prevention and treatment. This review analyzes the results of the cases' prevalence of urine leakage after partial nephrectomy with various approaches, occurrence's predictors of urinary fistulas, possible ways of their intraoperative prevention and treatment methods. The obtained data show that the size of tumors, their endophytic nature and proximity to the kidney pelvicalyceal system, as well as suturing of its defect, can be predictors of the development of urinary fistulas (UFs). Some authors point to the influence of long ischemia time and high blood loss on the occurrence of UFs. The main method of treating UFs is ureteral stenting or percutaneous drainage of the kidney pelvicalyceal system. For long-term persistent UFs, the method of choice can be simultaneous introduction of 2 stents, retrograde or percutaneous injection of fibrin glue, percutaneous cryoablation of the UFs.

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Sodium Fluorescein for Identification of Intraoperative Urine Leaks During Partial Nephrectomy

Cited by 3 publications

References 0 publications

Retrograde endoscopic assisted percutaneous treatment of urinary fistulas after partial nephrectomy

Retrograde endoscopic assisted percutaneous treatment of urinary fistulas after partial nephrectomy

Re: Rui Farinha, Giuseppe Rosiello, Artur De Oliveira Paludo, et al. Selective Suturing or Sutureless Technique in Robot-assisted Partial Nephrectomy: Results from a Propensity-score Matched Analysis. Eur Urol Focus. In press. https://doi.org/10.1016/j.euf.2021.03.019

Urinary fistulas after partial nephrectomy in renal cell carcinoma

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