NE-AUA 2006 Annual Meeting, September 28 - 30, 2006, The Westin Hotel & Rhode Island Convention Center Providence, Rhode Island
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Stentless Laparoscopic Partial Nephrectomy with Collecting System Entry
Christopher M. Lodowsky, MD, Gjanje Smith, md, Ralph Zagha, MD, Ingolf Tuerk, MD, PhD.
Lahey Clinic Medical Center, Burlington, MA,

Abstract: Conventional teaching advises placement of ureteral stents when the collecting system is violated during open or laparoscopic partial nephrectomy. Our goal is to determine if patients with a collecting system entry during laparoscopic partial nephrectomy managed without intraoperative placement of ureteral stent had a similar postoperative course compared to those who had ureteral stent placed.
Methods: Patients with a renal lesion suspicious for carcinoma who were treated with a laparoscopic partial nephrectomy were identified from a single surgeonís (IT) case log between October 2003 and April 2006. Upon retrospective review of a total of 66 cases, 24 patients were found to have entry into the collecting system. Collecting system entry was defined during the time of surgery by the primary surgeon. The following criteria were used: visualization of the collecting system, extravasation of urine or upon suspicion of entry the use of indigo carmine. From the initial evaluation to the follow-up, all of these patients had the same standard of care. However, the intraoperative management of the collecting system injury differed between two groups. Group A included 9 patients who had a ureteral stent placed during the initial surgery. Group B included 13 patients who did not have a ureteral stent placed during the initial surgery.
Results: A total of 22 patients who underwent a laparoscopic partial nephrectomy for a renal lesion suspicious for carcinoma had a collecting system injury; 9 in Group A and 13 in Group B. Mean followup for the study population was 21 months. There was no statistical difference between the groups when comparing demographic characteristics, tumor location, operative data, and oncological outcome. The average tumor size for Group A was 2.6 cm and for Group B was 3.8 cm. Group A had no postoperative complications but did require an additional office procedure for removal of the ureteral stent. In Group B, two patients developed a urine leak. One patient was treated with ureteral stent and foley catheter, and the other with ureteral stent, foley catheter, and percutaneous drainage of a perinephric urinoma.
Summary: Avoiding routine ureteral stent placement during laparoscopic partial nephrectomy with collecting system entry is safe and feasible. Careful patient selection with intraoperative decision making is critical in avoiding postoperative complications. A heightened awareness of signs and symptoms of urine leak is necessary to best care for these patients.


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