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Objective: To study the effect of ERAS on a textbook outcome (TO) after elective renal surgery. Patients and methods: Retrospective study of all patients who underwent a robot-assisted laparoscopic partial or radical nephrectomy or robot-assisted laparoscopic radical nephroureterectomy in Medisch Spectrum Twente (MST), Enschede, the Netherlands. In total, 277 patients were included. 66 patients from 2018 to 2021 (pre-ERAS group) and 211 patients from 2021 to 2023 (ERAS group). TO is a maximum of two nights in the hospital after surgery, no severe complications during or after surgery ≥ grade IIIb, no blood transfusions, no intensive care, no readmissions, and no mortality within 30 days after surgery. Comparisons were made between the pre-ERAS and ERAS groups using unpaired t-test, Mann–Whitney U test, the chi-squared test or Fisher's exact test. Multivariate logistic regression was used to adjust for possible confounding. Results: TO was significantly (p = 0.005) better in the ERAS group (TO = 76.8%) compared to the pre-ERAS group (TO = 59.1%). Compared to a pre-ERAS patient, the adjusted odds ratio for achieving a TO as an ERAS patient is 2.1 (95% CI 1.15–3.78). Conclusions: The implementation of ERAS showed a positive effect on the TO of elective renal surgery patients. [ABSTRACT FROM AUTHOR]

Background: Renal vascularization is classically described as a renal artery and vein. However, this vascular pattern presents numerous anatomical variations in terms of their number, origin and course due to ontogenetic alterations. The aim was to carry out a descriptive study of the renal vascular pattern observed during the dissection of cadavers intended for teaching purposes. Materials and methods: A descriptive and observational study of renal vascular anatomy was carried out by dissecting 16 renal blocks from 8 cadavers donated to science and used for teaching at the Faculty of Medicine of the University of Zaragoza. Results: The prevalence of arterial variations was 75% (56.3% for polar renal arteries, 12.5% for pre-hilar branching and 6.25% for double communicating arterial arch) and venous was 62.5% (12.5% for polar renal veins, 25% for late venous confluence, 6.25% for triple renal vein and 18.75% for double circumaortic renal vein). Conclusions: We conclude that the renal vascular anomalies occur with high frequency; for this reason, knowledge of these anomalies is extremely important for the correct planning of numerous medical-surgical activities. [ABSTRACT FROM AUTHOR]

ABSTRACTBackground This study aimed to assess pulmonary functions after either continuous thoracic paravertebral block (cTPVB) or thoracic epidural block (cTEB) in open renal surgeries.Methodsː The double-blinded, randomized clinical trial included 40 patients scheduled for open renal surgeries at Urology Hospital-Assiut University, equally assigned into group E (n = 20) and group P (n = 20), both at the level of 7th-8th thoracic vertebra. Initially, 7.5–12 mL of bupivacaine 0.25% was started before the induction of general anesthesia, followed by bupivacaine 0.125% continuously at a rate of 5–15 ml/h. Forced vital capacity (FVC) measured every 6 hours postoperatively within the first 24 hours was the primary outcome. Secondary outcomes were peak expiratory flow rate (PEFR), forced expiratory volume in the first second (FEV1), diaphragmatic excursion (DE), postoperative analgesia, total opioid consumption, total local anesthetic dose, hemodynamics and complications.Resultsː FVC, FEV1 and DE were better preserved in cTPVB where the lowest postoperative readings as a fraction of preoperative control were 0.7 ± 0.11 vs 0.65 ± 0.11 L, 0.74 ± 0.11 vs 0.64 ± 0.10 L and 0.73 ± 0.1 vs 0.58 ± 0.1 cm, respectively. The lowest postoperative PEFR was reported in cTEB (p-value = 0.128). Analysis of numeric rating pain scale, total opioid consumption and time of first rescue analgesic request revealed a statistical nonsignificant difference. The total infused dose of local anesthetic was significantly higher in cTPVB group. Incidence of sympatholytic complications was higher in cTEB.Conclusion cTEB and cTPVB had convergent effect on respiratory function and diaphragmatic motility and equivalent analgesic efficacy after open renal surgeries. Although cTPVB was technically easier and less time-consuming than cTEB, higher dose of local anaesthetic was required in cTPVB.

Background and Aims: Paravertebral block (PVB) is the regional anaesthesia of choice for percutaneous nephrolithotomy (PCNL). Erector spinae plane block (ESPB) is also effective for the same.This study aims to compare the analgesic efficacy and ease of performing PVB or ESPB for PCNL surgery. Methods: This study was conducted in 60 patients undergoing PCNL, who were randomised to Group P (n = 30; received ultrasound-guided [USG] PVB) and Group E (n = 30; received USG ESPB) after general anaesthesia. Blocks were administered at T10 level on the side of the surgery using 20 ml of 0.25% bupivacaine. The trachea was extubated at the end of surgery. The primary outcome was analgesia duration, and secondary outcomes were postoperative pain scores, analgesic consumption, ease of block performance, time taken to perform the block and complications between the two groups. Continuous variables were compared using an independent sample t-test, and categorical variables were analysed using Pearson's Chi-square test. Results: Demographic variables were comparable in both groups. The mean (standard deviation [SD]) time of first rescue analgesia in Group P and Group E were 16.6 (20.4)(95% confidence interval [CI]: 9.02–20.32) h and 16.3 (21.8) (95% CI: 8.17–24.51) h, respectively (P = 0.95). The postoperative pain scores and number of doses of analgesics used were comparable between the groups (P > 0.05). The time taken to perform PVB was much longer compared to the time taken to perform ESPB (P = 0.01). Conclusion: USG PVB and ESPB were equally effective for postoperative analgesia for PCNL surgery. [ABSTRACT FROM AUTHOR]

Background: This study aimed to assess pulmonary functions after either continuous thoracic paravertebral block (cTPVB) or thoracic epidural block (cTEB) in open renal surgeries. Methods: The double-blinded, randomized clinical trial included 40 patients scheduled for open renal surgeries at Urology Hospital-Assiut University, equally assigned into group E (n = 20) and group P (n = 20), both at the level of 7th-8th thoracic vertebra. Initially, 7.5-12 mL of bupivacaine 0.25% was started before the induction of general anesthesia, followed by bupivacaine 0.125% continuously at a rate of 5-15 ml/h. Forced vital capacity (FVC) measured every 6 hours postoperatively within the first 24 hours was the primary outcome. Secondary outcomes were peak expiratory flow rate (PEFR), forced expiratory volume in the first second (FEV1), diaphragmatic excursion (DE), postoperative analgesia, total opioid consumption, total local anesthetic dose, hemodynamics and complications. Results: FVC, FEV1 and DE were better preserved in cTPVB where the lowest postoperative readings as a fraction of preoperative control were 0.7 ± 0.11 vs 0.65 ± 0.11 L, 0.74 ± 0.11 vs 0.64 ± 0.10 L and 0.73 ± 0.1 vs 0.58 ± 0.1 cm, respectively. The lowest postoperative PEFR was reported in cTEB (p-value = 0.128). Analysis of numeric rating pain scale, total opioid consumption and time of first rescue analgesic request revealed a statistical nonsignificant difference. The total infused dose of local anesthetic was significantly higher in cTPVB group. Incidence of sympatholytic complications was higher in cTEB. Conclusion: cTEB and cTPVB had convergent effect on respiratory function and diaphragmatic motility and equivalent analgesic efficacy after open renal surgeries. Although cTPVB was technically easier and less time-consuming than cTEB, higher dose of local anaesthetic was required in cTPVB. [ABSTRACT FROM AUTHOR]

The treatment of bilateral Wilms tumors (BWT) involves curing the cancer, preserving long-term renal function, and maintaining a good quality of life. Established methods for achieving these goals include preoperative chemotherapy and nephron-sparing surgery (NSS). This study aimed to evaluate the experience of a single institution in treating patients with BWT. We analyzed cases of BWT treated at the Pediatric Oncology Institute—GRAACC—Federal University of São Paulo over a period of 35 years. Bleeding control was performed with manual compression of the renal parenchyma. Thirty-three patients were included in the study. Thirty cases were synchronous tumors. The mean age at diagnosis was 30.4 months (±22 m) and 66.7% were girls. The median follow-up period was 83 months. Neoadjuvant chemotherapy was the primary approach in most patients (87.9%), with a simultaneous upfront surgical approach performed in 84.8%. Most patients underwent bilateral NSS (70.4%). There were no early complications in this series, but 39.4% had clinical complications. The five-year survival rate was 76%. Therefore, it is clear that the surgical approach to BWT plays a crucial role in achieving good outcomes. However, it is difficult to standardize surgical techniques and technology may have the potential to enhance safety. [ABSTRACT FROM AUTHOR]

Introduction: acute postoperative pain delays the patient's functional recovery. Objective: to evaluate the utility of ketamine associated with morphine administered in intravenous boluses in the control of acute postoperative pain in patients undergoing elective renal surgery. Material and methods: we conducted a double-blind study in patients with moderate-severe postoperative pain undergoing elective renal surgery. Two groups were formed: group MK administered 0.05 mg/kg morphine plus 0.2 mg/kg ketamine and group M 0.05 mg/kg morphine plus 0.9% saline solution. Patients with pain of moderate-severe intensity according to the visual analogue scale received doses of morphine every 20 minutes until achieving light pain, recording the total consumption of morphine per patient. Blood pressure, heart and respiratory rates, oxygen saturation, and adverse effects were evaluated with the same periodicity. Results: MK group showed lower pain intensity with a significant decrease in morphine consumption. Both groups turned out to be similar in terms of blood pressure, heart rate, respiratory rate and oxygen saturation figures. Nausea and vomiting were the most prevalent adverse effects, being higher in the morphine group. Conclusions: the morphine-ketamine association was useful in the control of moderate-severe pain in patients undergoing elective renal surgery. [ABSTRACT FROM AUTHOR]

Objective: To test the hypothesis that longer warm ischaemia time (WIT) might have a marginal impact on renal functional outcomes and might, in fact, reduce haemorrhagic risk intra‐operatively. Patients and Methods: Data from 1140 patients treated with elective partial nephrectomy (PN) for a cT1‐2 cN0 cM0 renal mass were prospectively collected. WIT was defined as the duration of clamping of the main renal artery with no refrigeration and was tested as a continuous variable. The primary outcome of the study was evaluation of the effect of WIT on renal function (estimated glomerular filtration rate [eGFR]) postoperatively, at 6 months and in the long term (measured between 1 and 5 years after surgery). The secondary outcome of the study was haemorrhagic risk, defined as estimated blood loss (EBL) or peri‐operative transfusions. Multivariable linear, logistic and Cox regression analyses, accounting for age, Charlson comorbidity index, clinical size, preoperative eGFR and year of surgery, were used and the potential nonlinear relationship between WIT and the study outcomes was modelled using restricted cubic splines. Results: A total of 863 patients (76%) underwent PN with WIT and 277 (24%) without. The baseline median eGFR was 87.3 (68.8–99.2) mL/min/1.73m2 for the on‐clamp population and 80.6 (63.2–95.2) mL/min/1.73m2 for the off‐clamp population. The median duration of WIT was 17 (13–21) min. At multivariable analyses predicting renal function, longer WIT was associated with decreased postoperative eGFR (estimate: −0.21, 95% confidence interval [CI] −0.31; −0.11 [P < 0.001]). Conversely, no association between WIT and eGFR was recorded at 6‐month or long‐term follow‐up (all P > 0.8). At multivariable analyses predicting haemorrhagic risk, clampless resection with no ischaemia time and PN with short WIT was associated with an increased EBL (estimate: −21.56, 95% CI −28.33; −14.79 [P < 0.001]) and peri‐operative transfusion rate (estimate: −0.009, 95% CI −0.01; −0.003 [P = 0.002]). No association between WIT and positive surgical margin status was recorded (all P = 0.1). Conclusion: Patients and clinicians should be aware that performing PN with very limited or even with zero WIT might increase bleeding and the need for peri‐operative transfusion while not improving long‐term renal function outcomes. [ABSTRACT FROM AUTHOR]

Background and Aims: Paravertebral block (PVB) is the regional anaesthesia of choice for percutaneous nephrolithotomy (PCNL). Erector spinae plane block (ESPB) is also effective for the same.This study aims to compare the analgesic efficacy and ease of performing PVB or ESPB for PCNL surgery. Methods: This study was conducted in 60 patients undergoing PCNL, who were randomised to Group P (n = 30; received ultrasound-guided [USG] PVB) and Group E (n = 30; received USG ESPB) after general anaesthesia. Blocks were administered at T10 level on the side of the surgery using 20 ml of 0.25% bupivacaine. The trachea was extubated at the end of surgery. The primary outcome was analgesia duration, and secondary outcomes were postoperative pain scores, analgesic consumption, ease of block performance, time taken to perform the block and complications between the two groups. Continuous variables were compared using an independent sample t-test, and categorical variables were analysed using Pearson's Chi-square test. Results: Demographic variables were comparable in both groups. The mean (standard deviation [SD]) time of first rescue analgesia in Group P and Group E were 16.6 (20.4)(95% confidence interval [CI]: 9.02–20.32) h and 16.3 (21.8) (95% CI: 8.17–24.51) h, respectively (P = 0.95). The postoperative pain scores and number of doses of analgesics used were comparable between the groups (P > 0.05). The time taken to perform PVB was much longer compared to the time taken to perform ESPB (P = 0.01). Conclusion: USG PVB and ESPB were equally effective for postoperative analgesia for PCNL surgery.

This article discusses the use of a novel technique called transincisional quadratus lumborum block (QLB) in robotic and laparoscopic renal and adrenal surgery. The QLB is a regional anesthetic block that allows for effective pain management during surgery. The technique involves delivering local anesthetic through the lumbar interfacial triangle to the thoracolumbar fascia, which provides visceral analgesia. The article describes the steps of the procedure and highlights the potential advantages of this technique, including improved efficiency and reduced operating time. However, the article also acknowledges the limitations of the study and the need for further research to compare transincisional QLB with other approaches. [Extracted from the article]

The treatment of bilateral Wilms tumors (BWT) involves curing the cancer, preserving long-term renal function, and maintaining a good quality of life. Established methods for achieving these goals include preoperative chemotherapy and nephron-sparing surgery (NSS). This study aimed to evaluate the experience of a single institution in treating patients with BWT. We analyzed cases of BWT treated at the Pediatric Oncology Institute—GRAACC—Federal University of São Paulo over a period of 35 years. Bleeding control was performed with manual compression of the renal parenchyma. Thirty-three patients were included in the study. Thirty cases were synchronous tumors. The mean age at diagnosis was 30.4 months (±22 m) and 66.7% were girls. The median follow-up period was 83 months. Neoadjuvant chemotherapy was the primary approach in most patients (87.9%), with a simultaneous upfront surgical approach performed in 84.8%. Most patients underwent bilateral NSS (70.4%). There were no early complications in this series, but 39.4% had clinical complications. The five-year survival rate was 76%. Therefore, it is clear that the surgical approach to BWT plays a crucial role in achieving good outcomes. However, it is difficult to standardize surgical techniques and technology may have the potential to enhance safety.

Background: Ultrasound‐guided quadratus lumborum block (QLB) is considered a novel nerve block for postoperative pain control. However, its efficacy after urological surgery remains unclear. Objectives: The purpose of the current meta‐analysis was to evaluate the effects of the QLB block versus control (placebo or no injection) on postoperative pain and other adverse outcomes after urological surgery, providing extensive evidence of whether quadratus lumborum block is suitable for pain management after urological surgery. Study design: Systematic review with meta‐analysis of randomized clinical trials. Methods: We searched PubMed, Cochrane Library, Embase, Web of Science, and ClinicalTrials.gov to collect studies investigating the effects of QLB on analgesia after urological surgery. The primary outcomes included visual analog scale (VAS) at rest and during movement, 24‐h postoperative morphine consumption, and the incidence of postoperative nausea and vomiting (PONV). Results: Overall, 13 randomized controlled trials (RCTs) were reviewed, including 751 patients who underwent urological surgery. The QLB group exhibited a lower VAS score postoperatively at rest or on movement at 0, 6, 12, and 24 h, with less 24‐h postoperative morphine consumption and lower incidence of PONV. Limitations: Although the result is stable, heterogeneity exists in the current research. Conclusions: QLB exhibited a favorable effect of postoperative analgesia with reduced postoperative complications at rest or during movement after urological surgery. However, it is still a novel technology at a primary stage, which needs further research to develop. [ABSTRACT FROM AUTHOR]

Copyright of Journal of Reconstructive Urology is the property of Turkiye Klinikleri and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Single-port (SP) robotic surgery is a novel technology and is at the beginning of its adoption curve in urology. The goal of this narrative review is to provide an overview of SProbotic partial nephrectomy (PN) 4 years after the introduction of the da Vinci SP dedicated platform, focusing on perioperative outcomes, length of stay, and surgical technique. A nonsystematic review of the literature was conducted. The research included the most updated articles that referred to SP robotic PN. Since its commercial release in 2018, several institutions have reproduced robotic PN by using the SP platform, both via a transperitoneal and a retroperitoneal approach. The published SP-robotic PN series are generally based on preliminary experiences by surgeons who had previous experience with conventional multiarms robotic platforms. The reported outcomes are encouraging. Overall, three studies reported that SP-robotic PN cases had nonsignificantly different operative time, estimated blood loss, overall complications rate, and length of stay compared to the conventional ‘multiarms’ robotic PN. However, in all these series, renal masses treated by SP had overall lower complexity. Moreover, two studies underlined decreased postoperative pain as a major pro of adopting the SP system. This should reduce/avoid the need for opioids after surgery. No study compared SP-robotic versus multi-arms robotic PN in cost-effectiveness. Published experience with SP-robotic PN has reported the feasibility and safety of the approach. Preliminary results are encouraging and at least noninferior with respect to those from the multi-arms series. Prospective comparative studies with long-term oncologic and functional results are awaited to draw more definitive conclusions and better establish the more appropriate indications of SP robotics in the field of PN. [ABSTRACT FROM AUTHOR]

: Open renal surgeries are usually associated with significant pain which may increase morbidity and mortality if left untreated. Several methods are used to control pain after these surgeries including opioids, non-steroidal anti-inflammatory drugs and regional anesthetic techniques. This study aimed at comparing the thoracic paravertebral block (PVB) versus transversus abdominis plane block (TAP) in patients undergoing open renal surgeries. : Between November 2017 and November 2018 at Assiut University Hospital, urology department 60 patients undergone open renal surgeries had been randomly allocated into two groups; group (PVB) (n = 30) who received (PVB), and group (TAP) (n = 30) who received TAP block. The regional anesthetic technique was performed in each patient after induction of general anesthesia and before performing the surgery. The primary outcome was the total analgesic consumption in the first 24 h postoperatively. Secondary outcomes included the time to the first analgesic request and the Visual Analogue Scale score (VAS) during the first 24 h postoperatively. : Total analgesic consumption during the first 24 h postoperatively was significantly lower in PVB group compared to TAP group. The VAS scores were significantly lower in PVB group compared to TAP group during the first 12 h postoperatively. However, the time to first analgesic request was non-significant between both groups. : The TAP block was effective, safe and comparable to PVB for pain control following open renal surgeries. However, the paravertebral block was more potent. : ClinicalTrials.gov: NCT04697420 [ABSTRACT FROM AUTHOR]

Background : Open renal surgeries are usually associated with significant pain which may increase morbidity and mortality if left untreated. Several methods are used to control pain after these surgeries including opioids, non-steroidal anti-inflammatory drugs and regional anesthetic techniques. This study aimed at comparing the thoracic paravertebral block (PVB) versus transversus abdominis plane block (TAP) in patients undergoing open renal surgeries. Methods : Between November 2017 and November 2018 at Assiut University Hospital, urology department 60 patients undergone open renal surgeries had been randomly allocated into two groups; group (PVB) (n = 30) who received (PVB), and group (TAP) (n = 30) who received TAP block. The regional anesthetic technique was performed in each patient after induction of general anesthesia and before performing the surgery. The primary outcome was the total analgesic consumption in the first 24 h postoperatively. Secondary outcomes included the time to the first analgesic request and the Visual Analogue Scale score (VAS) during the first 24 h postoperatively. Results : Total analgesic consumption during the first 24 h postoperatively was significantly lower in PVB group compared to TAP group. The VAS scores were significantly lower in PVB group compared to TAP group during the first 12 h postoperatively. However, the time to first analgesic request was non-significant between both groups. Conclusions : The TAP block was effective, safe and comparable to PVB for pain control following open renal surgeries. However, the paravertebral block was more potent. Trial Registry : ClinicalTrials.gov: NCT04697420

To examine the association between surgical waiting times (SWTs) and all-cause mortality (ACM) in non-metastatic patients with RCC, in relation to tumour stage. This nation-wide population-based cohort study included 9,918 M0 RCC patients registered in the National Swedish Kidney Cancer Register, between 2009 and 2021, followed-up for ACM until 9 December 2021, and having measured SWTs. The associations between primarily SWTs from date of radiological diagnosis to date of surgery (WRS) and secondarily SWTs from date of radiological diagnosis to date of treatment decision (WRT) and date of treatment decision to date of surgery (WTS), in relation to ACM, were analysed using Cox regression analysis, adjusted for clinical and demographic characteristics, stratified and unstratified according to T-stage. During a mean follow-up time of 5 years (49,873 person-years), 23% (n = 2291) of the patients died. The adjusted hazard ratio (AHR) for WRS (months) for all patients was 1.03 (95% confidence interval [CI] = 1.02–1.04; p < 0.001). When subdividing WRS on T-stage, the AHRs were 1.03 (95% CI = 1.01–1.04; p < 0.001) and 1.05 (95% CI = 1.02–1.08; p = 0.003) for stages T1 and T3, respectively, while non-significant for T2 (p = 0.079) and T4 (p = 0.807). Similar results were obtained for WRT and WTS. Prolonged SWTs significantly increased the risk of early overall death among patients with RCC. The increased risk of early death from any cause show the importance of shortening SWTs in clinical work of patients with this malignant disease. [ABSTRACT FROM AUTHOR]

Anomalous blood vessels are important from the clinical aspects such as hydronephrosis, Varicocele leading to risk of infarction of kidney during renal transplant surgeries. Here, we report a case series of 30 cadavers of male and female aged between 40- 80 years in the Department of Anatomy of a tertiary care institute in Bangalore, India. In three male cadavers, there was a variation in right testicular artery arising from abdominal aorta above the right renal artery later coursing downward, giving a branch to right kidney (10%). In another two male cadavers, right testicular artery (6.6%) was arising as branch of abdominal aorta above the right renal artery later coursing downward giving branch to right suprarenal gland and also observed right accessory renal artery branch of abdominal aorta arising below superior mesenteric artery and coursing upward to lower pole of right kidney. Observed in two male cadaver, inferior phrenic artery was arising as a common trunk from abdominal aorta above the main renal vessels and coursing laterally upward to diaphragm (6.6%). All the other branches of abdominal aorta and venous drainage were normal in the dissection of cadavers. The knowledge of these variations of arteries are essential before performing any transplantation surgeries, thus one can avoid the complications during uroradiological interventions.

BackgroundParavertebral block (PVB) has been widely used in postoperative analgesia, especially in thoracic and breast surgery. However, the efficacy and safety of PVB for analgesia after renal surgery remains uncertain. Therefore, this study aimed to determine the postoperative analgesic efficacy and safety of PVB in renal surgery.MethodsPubMed, Web of Science, Embase, and the Cochrane Library databases were systematically searched up to December 20, 2021. All randomized controlled trials (RCTs) evaluating the postoperative analgesic efficacy of PVB in renal surgery were collected. The meta-analysis was performed using RevMan 5.4 and Stata/MP 14.0 software.ResultsA total of 16 RCTs involving 907 patients were included in the meta-analysis. Ten studies investigated patients under percutaneous nephrolithotomy (PCNL), and six studies were done for patients under other renal surgery (nephrectomy or pyeloplasty). Compared with control groups (no block, sham block, or other nerve blocks), meta-analysis showed that PVB reduced 24-hour postoperative opioid consumption significantly (SMD = −0.99, 95%CI: −1.60–0.38, p = 0.001, I2 = 92%) and reduced pain scores at various time points within 24 h at rest and 1 h, 4 h, and 24 h at movement after renal surgery, furthermore, PVB prolonged the time to first postoperative analgesic requirement (SMD = 2.16, 95%CI: 0.94–3.39, p = 0.005, I2 = 96%) and reduced the incidence of postoperative additional analgesia (OR = 0.14, 95%CI: 0.06∼0.33, p

Background: Quadratus lumborum block (QLB) guided by ultrasound is a novel local block anesthesia technique, which can be used in various surgeries for multimodal analgesia. Its analgesic effectiveness for renal surgery is still uncertain. The aim of this meta-analysis was to assess the postoperative analgesic efficacy of QLB in adult patients undergoing renal surgery. Methods: We systematically searched randomized controlled trials (RCTs) through the databases of Cochrane Library, Embase, and PubMed until June 21, 2021. Postoperative consumption of opioid in the first 24-h was set as the primary outcome. The risk of bias was evaluated by Cochrane methodology. Results: Ten RCTs involving 577 patients were eligible for our inclusion criteria. Ultrasound-guided QLB significantly reduced postoperative consumption of opioid in the first 24 h after surgery (mean differences [MD] − 17.58, 95% confidence interval [CI] − 23.14 to − 12.02, P < 0.00001, I2 = 98%). Similarly, the results were consistent in subgroups analysis of both different types of renal surgeries and different QLB approaches. The QLB also significantly decreased postoperative static pain scores at different time points, and reduced the incidence of postoperative nausea and vomiting (PONV) (risk ratio [RR] = 0.48, 95% CI 0.33 to 0.70, P = 0.0002, I2 = 0%) and the number of rescue analgesia patients (RR = 0.34, 95% CI 0.20 to 0.58, P < 0.0001, I2 = 0%). No major complications related to QLB were reported in the included studies. Conclusions: Ultrasound-guided QLB improves postoperative analgesic efficacy and reduces PONV in adult patients undergoing renal surgery. There is currently limited evidence concerning the analgesic effects of different QLB approaches after renal surgery, and further research is required in this area. PROSPERO registration: PROSPERO Registration CRD42021260821. [ABSTRACT FROM AUTHOR]

Introduction: This is a case of a 55 year old female with an incidentally discovered right renal mass. CT scan showed a 4 cm low density lesion extending from the renal cortex into the renal vein and inferior vena cava (IVC) (level 1 thrombus) with fat content, suggestive of possible angiomyolipoma. Objective: To demonstrate the surgical steps of robotic partial nephrectomy with IVC thrombectomy. Methods: After trocar placement, the da Vinci Xi system is docked in the standard manner for right robotic partial nephrectomy. The procedure is initiated with mobilization of the colon followed by identification of the right ureter and gonadal vein. The gonadal vein is followed proximally to its insertion into the IVC. The renal vein and artery are subsequently identified and dissected. A vessel loop is passed around the renal vein to ensure proximal control of the tumor thrombus during excision of the mass. Intraoperative ultrasound is used to identify the location and depth of the mass prior to excision. Bulldog clamps are placed sequentially over the renal artery and renal vein. Traction is applied with a vessel loop and suction irrigator to ensure proximal control of the tumor thrombus. Excision of the mass is accomplished utilizing a combination of sharp and blunt dissection. An incision is made into the branch of the renal vein containing the tumor thrombus. The incision is extended circumferentially to facilitate mobilization and complete en bloc removal of the renal mass and thrombus. The renal vein defect is then closed in 2 layers with 4–0 Prolene suture. The tumor bed defect is closed in 2 layers in a continuous manner with 3–0 barbed suture. A sliding clip technique is then performed with 3–0 barbed suture in an interrupted manner to re-approximate the edges of the kidney and complete the reconstruction. Results: Estimated blood loss was 70 cc with a warm ischemia time of 45 min. The patient was discharged from the hospital on postoperative day number 1 without complications. Final pathology demonstrated a 2.1 cm angiomyolipoma with negative margins. Conclusion: Robotic partial nephrectomy with IVC thrombectomy is a feasible and safe surgical option for patients with suspected benign renal masses with extension of tumor thrombus into the IVC.

The synoptic operative report (SOR) is a model with several advantages but still not enough adopted. We studied the performance of a SOR template (FileMaker Pro®, FMP) versus the usual narrative operative report (NOR) template on DxCare® software (DXC) of the urology department at the Georges-Pompidou European Hospital by comparing the number of completed data, the completeness rate, the writing time, and the writing speed and by analyzing the learning curve. Over an 11-week period between March and June 2021, 118 case-control OR for 59 laparoscopic or open, partial or total nephrectomy procedures, for all indications were prospectively created. The number of completed data was higher on FMP (113, IQR: 92-122 vs. 59, IQR: 54-70). SOR done on FMP were more complete (95.1%±4.1 vs. 85.5%±6.1; P<0.001). Creation time was longer on FMP (9.07±2.94 vs. 7.66±2.88min; P=0.008). However, FMP generated a database and an OR faster than NOR (9.07±2.94 vs. 12.9±3.2min; P<0.001). The speed of data-filling was higher on FMP (12.9±3.5 vs. 9.2±3.7 data/min; P<0.001). There was a progressive improvement in SOR creation with a Pearson correlation coefficient of -0.313 (P=0.044) independent of the writer. The use of the SOR FMP template seems to be more efficient on data recording but an improvement of the template to make it faster to use should be sought through recommendations from a panel of experts. LEVEL OF EVIDENCE: 3., (Copyright © 2024 Elsevier Masson SAS. All rights reserved.)

Objectives: The aim of the study was to assess the efficacy and safety of an enhanced recovery program (ERP) after robot-assisted partial nephrectomy (RAPN) for cancer. Methods: It was a monocentric, retrospective, comparative study. An ERP after RAPN was introduced at our institution in 2015 and proposed to all consecutive patients admitted for RAPN. The control group for this study was composed of patients managed immediately before the introduction of the ERP. We collected information on patient characteristics, tumor sizes, ischemia times, biology, hospital length of stays, postoperative (≤30 days) complications, and readmission rates. Group comparisons were made using the Pearson χ2 test for qualitative data and the Student t test for quantitative data. Results: Between 2015 and 2017, 112 patients were included in the ERP group. Fifty patients were included in the control group. Ninety patients in the ERP group (80.4%) were discharged at or before postoperative day (POD) 2 versus 10 patients (20%) in the control group (p < 0.001). There was no significant difference between the ERP and control groups for the urinary retention rate (respectively 3.6 vs. 2%; p = 0.593). Resumption of normal bowel function was significantly shorter in the ERP group (94.6% at POD1 vs. 69.6% in the control group, p < 0.001). There were no significant differences for postoperative complications (15.2% in the ERP group vs. 20% in the control group, p = 0.447) or readmissions within 30 days (8.04 vs. 0.2%, p = 0.140). Conclusions: ERP after RAPN seems to reduce postoperative length of stay without increasing postoperative complications or readmissions. [ABSTRACT FROM AUTHOR]

Objective: In this study we aimed to present the data for patients followed-up and operated due to complex renal cysts using Bosniak classification system. Method: Data of all patients followed-up or underwent surgery via open / minimal invasive methods due to complex renal cysts in our clinic between 2016 and 2019 were retrospectively evaluated. Bosniak category IIF and higher lesions were included in the study. Results: A total of 83 patients were included in the study. The mean age of the patients was 52 ±10.1 years and 40 (48.2%) were male and 43 (51.8%) were female. Fifty-three (63.9%) patients had Bosniak IIF, 18 (21.7%) Bosniak III and 12 (14.5%) Bosniak IV lesions. Mean lesion size was 54±27.4 mm based on radiological evaluation. Surgery was performed in a total of 41 (49.4%) patients. Based on final pathology results, benign pathologies were detected in 13 (31.7%), clear cell renal cell carcinoma in 22 (53.7%), and papillary renal cell carcinoma in 6 (14.6%) patients. Malignancy rates were detected as 18.9%, 44.4% and 83.3% in Bosniak IIF, III and IV lesions, respectively. While the mean lesion size of the patients who had benign pathology was 64.6±18.4 mm, the mean lesion size of the patients with malign pathology was 58.3±29.7 mm (p = .41). Conclusion: Progression is an important finding of malignancy in Bosniak IIF lesions. An important amount of especially Bosniak III lesions are receiving unnecessary treatment. Thus, active surveillance is a treatment which should be considered in these patients. More comprehensive prospective randomized studies are needed. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate the safety and efficacy of transperitoneal laparoscopic pyelolithotomy in renal stone cases with previous renal surgeries. Patients and methods: In this prospective study, 190 consecutive patients with renal stones, who were candidates for transperitoneal laparoscopic pyelolithotomy, were enrolled. The patients were divided into two groups. In group A, 163 patients without a history of renal surgery underwent standard laparoscopic pyelolithotomy, whereas in group B laparoscopic pyelolithotomy was performed in 27 patients with a history of kidney stone surgery including percutaneous nephrolithotomy or open stone surgery. All intraoperative data including the operating time and complications such as bleeding requiring transfusion were recorded. Postoperative data such as length of hospitalization, hemoglobin level alteration, and other complications were also recorded. Results: There was no significant difference in the preoperative data such as stone size, stone site, age, sex, and stone side between the two groups. There was no significant difference in the stone-free rate between the two groups (p = 0.4). There was no significant difference between the two study groups regarding the operating time, hospital stay, stone-free rate, complications, and transfusion rate. Conclusion: Laparoscopic pyelolithotomy can be used as a safe and feasible treatment modality in the setting of previous renal surgery. The complications and stone-free rate of laparoscopic pyelolithotomy in patients with history of renal surgery are acceptable. [ABSTRACT FROM AUTHOR]

Introduction: Cardio pulmonary by pass is an adjunct that is routinely used for cardiac procedures to facilitate an immobile and blood less field and be able to alter the temperature and basal metabolic rate. It was observation study in cases where CPB was offered as an adjunct to surgery. As the procedures for each case varied, so did our approach need modifications for cannulation and conduct of bypass. Materials and methods: It was observational and retrospective study done from 2015 to 2020 in Department of Cardiothoracic Surgery with records in the hospital data base for the last 5 year. Results: We found that a total of 20 non cardiac procedures were performed CPB. These included 8 isolated limb perfusions for malignant melanoma, 4 tracheal surgery cases, 3 renal surgeries, 4 mediastinal masses and 1 neurosurgical case. 4 cases of mediastinal masses required CPB because of the proximity of the mass to a major vessel and/heart. To decompress the heart and hence the tumor to provide for a hassle free dissection. Conclusion: Patient outcomes have been favorable and encouraging with few complications. The different aspects of bypass being an effective cardio pulmonary substitute, the ability to generate varying flow rates, to warn or cool the patient to drain the vascular volume externally to be transfused back later make it as versatile tool that can be used in different fields of surgery. [ABSTRACT FROM AUTHOR]

Retroperitoneal lymphangiomas are exceedingly rare and typically asymptomatic. We present a case of a 27 year-old female with chronic right flank pain and cross-sectional imaging showing a large multi-cystic mass located medial and inferior to the right kidney. The patient underwent an uncomplicated robotic-assisted, laparoscopic resection of the mass with final pathology showing a benign lymphangioma. This case highlights the importance of recognizing retroperitoneal lymphangiomas as atypical causes of chronic flank pain and demonstrates that these benign tumors can be successfully resected robotically. Given today's urology residency training, urologists are likely uniquely positioned to best manage these peri-renal lymphatic malformations.

Even though several studies have demonstrated the effectiveness of opioid free anesthesia (OFA) strategies in pediatric patients, OFA has not been studied in pediatric renal surgery. We, therefore, conducted a prospective observational pilot study on a total of 26 children to assess the feasibility and efficacy of using a single injection ultrasound-guided paravertebral block (PVB) at T10 level with 0.4 mL/kg bupivacaine 0.25% in combination with sevoflurane as an OFA technique in elective open renal surgery. A successful PVB (defined in terms of both hemodynamic change after the skin incision and the use of rescue analgesia) was observed in 25 children (96%). The interval between PVB and skin incision was 21 min [IQR (18–25)]. End tidal sevoflurane concentration was 2.1% [IQR (1.8–2.4)]. The median time between extubation and waking was 2.5 min [IQR (1–4)]. The median Face, Legs, Activity, cry, Consolability score in post-anesthesia care unit was 1.00 [IQR (0–2)]. Blood pressure falls were not significant at different measurement times. None of the patients had complications related to PVB, and only one patient had post-operative vomiting. PVB is an attractive method that can procure an effective OFA in combination with sevoflurane in pediatric renal surgery. [ABSTRACT FROM AUTHOR]

To describe our institution's initial experience with radical (RN) and partial nephrectomy (PN) using the SP robotic system. The recent FDA approval of the da Vinci® SP robotic platform has led to its use in minimally invasive approaches to urologic malignancies. There are little data on its feasibility and safety after implementation for radical and partial nephrectomy. All patients who underwent PN or RN using the SP system at our institution were reviewed. All PNs were performed off-clamp. Patient demographics, preoperative imaging, operative approaches, and perioperative outcomes were collected and analyzed. Sixteen patients underwent PN (n = 13) or RN (n = 3) utilizing the SP robotic system between January 2019 and June 2019. Average age was 58.6 ± 13.9 and 61.0 ± 1.7 years in each group, respectively. A retroperitoneal approach was performed in 7 (53.8%) PN patients and 1 (33.3%) RN patient. A transperitoneal approach was performed in 6 (46.1%) PNs and 2 (66.7%) RNs. Mean operative time and median estimated blood loss for PN was 176.9 ± 64.0 min and 200 (50–800) ml compared to 176.3 ± 73.8 min and 50 (50–400) ml for RN. There was one operative conversion (7.7%) to an open approach in the PN group. Length of hospital stay postoperatively averaged 1.9 ± 1.3 days and 3.3 ± 1.2 days for patients undergoing partial and radical nephrectomy, respectively. SP partial and radical nephrectomies through transperitoneal and retroperitoneal approaches appear to be feasible surgical techniques in the management of cortical renal masses. Off-clamp PN is also a feasible approach using the SP system. However, further study is needed to establish its safety and use in renal surgery across multiple institutions and larger patient cohorts. [ABSTRACT FROM AUTHOR]

We report a case of chronic left flank neuropathic pain after a renal cyst removal in a 54-year old female. The patient was treated with a single application of capsaicin 8% dermal patch, with satisfactory results at an eight week follow up visit. Capsaicin 8% dermal patch could be a suitable alternative in the conservative management of post laparoscopy neuropathic pain, as it can be effective and has a well-tolerated safety profile. [ABSTRACT FROM AUTHOR]

Objectives: To explore the comparative effectiveness of partial nephrectomy (PN), radical nephrectomy (RN), ablative therapies (ablation) and active surveillance (AS) for small renal masses (SRMs; tumour diameter ≤4.0 cm) in the domains of survival, renal function and quality of life (QoL) using the prospectively maintained Delayed Intervention and Surveillance for Small Renal Masses (DISSRM) Registry. Patients and Methods: Estimated glomerular filtration rate (eGFR) was calculated from creatinine values to determine renal function. QoL was measured using the Short Form 12 (SF‐12) questionnaire. The Kaplan–Meier method and Cox proportional hazards regression were used for survival analysis. The mixed‐effects model was used for renal function and QoL analysis. Results: Of 638 patients, 231 (36.2%) chose PN, 41 (6.4%) RN, 27 (4.2%) ablation and 339 (53.1%) AS. Cancer‐specific survival at 7 years was 98.8% in PN patients and 100% in all other groups. Overall survival (OS) at 7 years was 87.9%, 90.2%, 83.5% and 66.1% in PN, RN, ablation and AS patients, respectively. The OS rate was significantly worse in the AS group than other groups and likely attributable to older age and increased comorbidities. The eGFR was lowest in RN patients but comparable in all other groups. QoL was lowest in AS patients due to lower physical health scores, but mental health scores were similar in all groups. Conclusions: With excellent oncological outcomes in all groups, nephron‐sparing approaches, like PN and ablation, are preferred over RN when intervention is indicated for SRMs. AS is a reasonable option for select patients, given the comparable oncological and mental health outcomes. [ABSTRACT FROM AUTHOR]

In the interest of renal functional preservation, partial nephrectomy has supplanted radical nephrectomy as the preferred treatment for T1 renal masses. This procedure usually involves the induction of renal warm ischemia by clamping the hilar vessels prior to tumor excision. Performing robot-assisted partial nephrectomy (RAPN) “off-clamp” can theoretically prevent renal functional loss associated with warm ischemia. We describe our institutional experience and compare perioperative and renal functional outcomes using a propensity score matched cohort. We conducted a retrospective comparison from a prospectively maintained database of all patients who underwent RAPN from 2009 to 2015. Of those patients, 143 underwent off-clamp RAPN. Fifty off-clamp RAPN patients were propensity score matched with fifty clamped RAPN patients based on renal function, tumor size, and R.E.N.A.L. nephrometry score. The cohorts were compared across demographics, operative information, perioperative outcomes, and renal functional outcomes. For all off-clamp RAPN patients, mean nephrometry score was 7.1, mean estimated blood loss (EBL) was 236.9 mL, perioperative complication rate was 7.7%, and mean decrease in estimated glomerular filtration rate (eGFR) was 7.1% at a median follow-up of 9.2 months. In the propensity score matched cohorts, off-clamp RAPN resulted in a shorter mean operative time (172.0 versus 196.0 min, p = 0.025) and a lower mean EBL (179.7 versus 283.2 mL, p = 0.046). A lower complication rate of 6.0% in the off-clamp group compared with 20.0% in the clamped group approached significance (p = 0.071). Mean preoperative eGFR was similar in both cohorts. Importantly, there was no significant difference in decrease in eGFR between the clamped cohort (9.8%) and off-clamp cohort (11.9%) at a median follow-up of 9.0 months (p = 0.620). Off-clamp RAPN did not result in improved renal functional preservation in our experience. Surprisingly, the off-clamp cohort experienced lower intraoperative blood loss, shorter operative times, and fewer complications. [ABSTRACT FROM AUTHOR]

The role of intraoperative intravenous lidocaine infusion has been previously evaluated for pain relief, inflammatory response, and post-operative recovery, particularly in abdominal surgery. The present study is a randomized double-blinded trial in which we evaluated whether IV lidocaine infusion reduces isoflurane requirement, intraoperative remifentanil consumption and time to post-operative recovery in non-laparoscopic renal surgery. Sixty patients scheduled to undergo elective non-laparoscopic renal surgery under general anesthesia were enrolled to receive either systemic lidocaine infusion (group L: bolus 1.5 mg/kg followed by a continuous infusion at the rate of 2 mg/kg/hr until skin closure) or normal saline (0.9% NaCl solution) (Group C). The depth of anesthesia was monitored using the Bispectral Index Scale (BIS), which is based on measurement of the patient’s cerebral electrical activity. Primary outcome of the study was End-tidal of isoflurane concentration (Et-Iso) at BIS values of 40–60. Secondary outcomes include remifentanil consumption during the operation and time to extubation. Et-Iso was significantly lower in group L than in group C (0.63% ± 0.10% vs 0.92% ± 0.11%, p