Xanthogranulomatous pyelonephritis: a comparison of open and minimally-invasive surgical approaches

Barboza, Marcelo; Nottingham, Charles U.; Calaway, Adam; Wei, Ting; Flack, Chandra K.; Cary, Clint; Boris, Ronald S.

doi:10.1007/s11701-020-01153-9

Cited by 9 publications

(18 citation statements)

References 22 publications

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“…Studies have shown favourable results for laparoscopic nephrectomy; Barboza et al in a recent case series showed less blood loss and shorter hospital stay in the laparoscopic nephrectomy group compared with open. 48 Asali et al's recent case series of 27 patients undergoing laparoscopic nephrectomy for XGP reported favourable results with only one patient requiring conversion to open procedure. 49 Campanairo et al similarly showed good results with the laparoscopic approach, including in the management of Stage 2 and 3 disease.…”

Section: Managementmentioning

confidence: 99%

“…In this study, 41.2% of the MIS group were completed with robotic assistance and promisingly, all of this group were completed without conversion to open. 48 There are multiple case reports of patients successfully undergoing curative partial nephrectomy for focal XGP; however, it should be observed that in most of these instances the presumptive pre-operative diagnosis was RCC. 51 Although there is limited data on nephronsparing surgery for XGP given its rarity, these case reports suggest it is a viable approach for focal XGP.…”

Section: Managementmentioning

confidence: 99%

Section: Managementmentioning

confidence: 99%

“…In this study, 41.2% of the MIS group were completed with robotic assistance and promisingly, all of this group were completed without conversion to open. 48 …”

Section: Managementmentioning

confidence: 99%

“…Given that there remains limited data available on open versus laparoscopic nephrectomy for XGP, the decision regarding the optimal surgical approach will ultimately depend on local expertise and extent of inflammation demonstrated on pre-operative CT. 48 …”

Section: Managementmentioning

confidence: 99%

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Xanthogranulomatous Pyelonephritis: A Narrative Review with Current Perspectives on Diagnostic Imaging and Management, Including Interventional Radiology Techniques

Bolger¹,

Hennebry²,

Byrne³

et al. 2021

IJNRD

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Xanthogranulomatous Pyelonephritis (XGP) is a rare, chronic granulomatous inflammatory condition thought to arise secondary to a combination of obstruction, recurrent bacterial infection and an incomplete immune response resulting in focal or diffuse renal destruction. This destruction may be profound with the potential to infiltrate surrounding tissues and viscera. The imaging features of XGP can be ambiguous, mimicking malignancy, tuberculosis (TB) and malakoplakia earning the title of "the great imitator". Computed tomography (CT) is the mainstay of XGP diagnosis and staging, accurately quantifying the stone burden and staging the renal destruction, including the extent of extra-renal spread. Although some cases in children have been successfully treated with antibiotics alone, nephrectomy remains the most common treatment for XGP in adults. The specific management strategy needs to be tailored to individual patients given the potential constellation of renal and extrarenal abnormalities. Although XGP has classically required open nephrectomy, laparoscopic nephrectomy has an increasing role to play arising from the advancement in laparoscopic skills, technique and instruments. Nephron-sparing partial nephrectomy may be considered in the focal form. Interventional radiology techniques most often play a supportive role, eg, in the initial drainage of associated abscesses, but have rarely achieved renal salvage. This narrative review seeks to synthesise the existing literature and summarise the radiological approach and interventional radiology management situated in a clinical context.

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Section: Managementmentioning

confidence: 99%

Section: Managementmentioning

confidence: 99%

Section: Managementmentioning

confidence: 99%

“…In this study, 41.2% of the MIS group were completed with robotic assistance and promisingly, all of this group were completed without conversion to open. 48 …”

Section: Managementmentioning

confidence: 99%

Section: Managementmentioning

confidence: 99%

See 3 more Smart Citations

Xanthogranulomatous Pyelonephritis: A Narrative Review with Current Perspectives on Diagnostic Imaging and Management, Including Interventional Radiology Techniques

Bolger¹,

Hennebry²,

Byrne³

et al. 2021

IJNRD

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Xanthogranulomatous pyelonephritis: a review and meta-analysis with a focus on management

et al. 2022

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Nephrectomy for xanthogranulomatous pyelonephritis—a not-so-simple solution

Kelly,

Anderson,

Looney

et al. 2023

Ir J Med Sci

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Background Xanthogranulomatous pyelonephritis (XGP) is a rare chronic inflammatory condition of the kidney, associated with high patient morbidity, often requiring targeted antibiotic therapy and surgical removal of the affected kidney. Aim We report the outcomes of patients undergoing nephrectomy for XGP in our institution over a 12-year period. Methods Following ethical approval, a retrospective review of histological samples of renal tissue demonstrating features of XGP from June 2010 to 2022 was conducted. Laboratory, imaging, and clinical data of included participants were collected. Results Eleven patients were included (8 women, 3 men), mean age of 58.1 (35–81). Recurrent urinary tract infection was the most common clinical presentation (55%, n = 6). Other presentations included flank pain (36%, n = 4), collection/ abscess (45%, n = 5), and nephro-cutaneous fistulae (9%, n = 1). The majority of patients had bacteriuria (91%, n = 10), and Escherichia coli was the most common bacteria isolated (55%, n = 6). Antibiotic resistance was seen in 60% of positive urine samples (n = 6). An open nephrectomy was performed in all but one case (91%, n = 10). A postoperative complication occurred in 73% (n = 8), with 50% (n = 4) of complications Clavien Dindo grade 3 or higher, including one patient mortality. Conclusions XGP is a difficult and complex condition to treat. All patients in this series presented with infection or associated sequelae thereof. Complex XGP cases therefore often require open nephrectomy and have high rates of postoperative complications. Careful consideration of antibiotic and operative intervention is therefore essential to ensure the best outcome for these patients.

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Xanthogranulomatous pyelonephritis: a comparison of open and minimally-invasive surgical approaches

Cited by 9 publications

References 22 publications

Xanthogranulomatous Pyelonephritis: A Narrative Review with Current Perspectives on Diagnostic Imaging and Management, Including Interventional Radiology Techniques

Xanthogranulomatous Pyelonephritis: A Narrative Review with Current Perspectives on Diagnostic Imaging and Management, Including Interventional Radiology Techniques

Xanthogranulomatous pyelonephritis: a review and meta-analysis with a focus on management

Nephrectomy for xanthogranulomatous pyelonephritis—a not-so-simple solution

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