Ces Urol 2015, 19(2):118-130 | DOI: 10.48095/cccu2015022

Renal Ischemia in Partial Nephrectomy and Options for Its Influence

Petr Stránský¹, Milan Hora¹, Jan Hrbáček², Viktor Eret¹, Tomáš Ürge¹, Renáta Peteříková³

¹ Urologická klinika FN Plzeň²Urologická klinika FN Motol, Praha

³ Oddělení specializačního vzdělávání LF UK Plzeň

Stránský P, Hora M, Hrbáček J, Eret V, Ürge T, Peteříková R. Renal ischemia in partial nephrectomy and options for its influence Introduction: The objective of this literature review was to summarize clinical and experimental evidence of the renal responses to warm and cold ischemia. The study compared different surgical procedures and options for dealing with renal ischemia during partial nephrectomy. The article is a summary of the current literature data.

Results: There are three main mechanisms of ischemic renal injury - vascular, persistent vasoconstriction with an abnormal endothelial cell compensatory response, and tubular obstruction, with backflow of urine, and injury due to reperfusion. Controversy regarding the maximal kidney tolerability to warm ischemia continues. This communication summarizes literary data regarding available surgical techniques used to diminish the effects of warm ischemia.

Conclusion: If ischemia is required, the tumour should be removed within 25 minutes of warm ischemia, regardless of the surgical approach. If this longer time of resection is expected, we have to start immediately with cold ischemia. Cold ischemia, depending on the cooling method, can be tolerated for up to 2 hours (autotransplantation). The cold ischemia technique includes in situ cold arterial perfusion, ice slush placed around the kidney, retrograde caliceal perfusion or ex situ cold arterial perfusion with autotransplantation. The technique depends on preoperative findings, surgical technique (open, laparoscopic or robotic) and institutional experience.

Keywords: Ischemia, renal cell carcinoma, partial nephrectomy, kidney failure.

Received: January 6, 2015; Accepted: June 19, 2015; Prepublished online: June 19, 2015; Published: July 5, 2015