PURPOSE: Laparoscopic nephrectomy with autotransplantation (LNA) is a viable option when renal preservation is required or ureteral reconstruction is impossible.
This study reports our long-term experience with LNA.
MATERIALS AND METHODS: Retrospective review of data of all patients who underwent LNA since 2000, revealed data for 52/59 patients after exclusions. Indications for LNA included ureteral stricture disease (41), renal malignancy (7), ptotic kidney (1), chronic flank pain (1), renal artery aneurysm (1), and renovascular hypertension (1). Follow-up included ultrasonography, nuclear renography and computerized tomography. Complications analyzed were Clavien-Dindo grade III or higher.
RESULTS: 52 patients (30/52 women [57.6%]) underwent LNA at a median age of 48 years (range 12-76). At a median follow-up of 73.5 months, 47/52 patients (90.3%) had long-term function of the autotransplanted renal unit; including 3/4 (75%) solitary kidneys. Five patients (9.7%) experienced renal unit failure at a median of 15 months. Three of the five patients required nephrectomy of autotransplant unit secondary to renal vein thrombosis (1 day), pseudoaneurysm (15 months), and chronic pain (48 months). Four patients had early and 8 patients had late complications. Four patients in the tumor group had disease progression; all are alive.
CONCLUSIONS: LNA is an excellent long-term surgical option (>90% success with >6 year median follow-up) for complex ureteral and renal malady that necessitates preservation of renal parenchyma. Tumor progression is possible after ex vivo tumor excision; therefore, careful patient selection and follow-up are mandatory. This report supports the safety, efficacy and durability of LNA in experienced hands.
Written by:
Tran G, Ramaswamy K, Chi T, Meng M, Freise C, Stoller ML. Are you the author?
School of Medicine, University of California, San Francisco; Department of Urology, University of California, San Francisco; Department of Surgery, University of California, San Francisco.
Reference: J Urol. 2015 Mar 20. pii: S0022-5347(15)03387-X.
doi: 10.1016/j.juro.2015.03.089
PubMed Abstract
PMID: 25801764