Theory and Practice in Medicine, 2015, Vol. 21, No. 2.2
THE COMPLICATIONS RISK OF NEPHRECTOMIES IN PATIENTS UNDERGOING RENAL REPLACEMENT THERAPY
Henrikas Ramonas, Rosita Bazarauskaitė, Genadijus Kučinskis, Arūnas Želvys
Correspondence Address: firstname.lastname@example.org
Key words: complications of nephrectomy, pretransplant nephrectomy, polycystic kidney disease, arteriovenous access.
Objective. The aim of this study is to estimate the complications risk of nephrectomies in patients undergoing renal replacement therapy, and to analyse its reasons.
Materials and methods. 158 nephrectomies were performed in 136 patients undergoing renal replacement therapy at the Urology Centre of the Vilnius University Hospital Santariskiu klinikos in the period from 1999 till 2013. A retrospective analysis of surgical treatment complications was performed.
The mean age of the patients was 52,36 years. The indication to perform nephrectomy was polycystic kidney disease and renal cysts in 50 (31,64 %) patients, nephrolithiasis in 44 (27,84 %), malignant or benign renal masses or other tumours with extension to upper urinary tract in 34 (21,52 %), obstructive or reflux nephropathy in 18 (11,40 %), and other indications in 12 (7,6 %) patients. Simultaneous bilateral nefrectomy was performed in 32 (23,53 %) cases. The complications risk of nefrectomies was assessed by analysing the relationship between the intraoperative, early postoperative, and arteriovenous
access complications and preoperative factors, and intraoperative peculiarities.
Results. The intraoperative complications were reported in 12 (7,6 %) cases of nefrectomies. The postoperative complications were diagnosed in 28 (17,73 %) cases, and the most common complication was postoperative bleeding. 9 (6,62 %) patients died. The dialysis access complications was diagnosed in 20 (12,66 %) cases of nephrectomies. The treated disease itself and intraoperative factors did not affect the genesis of intraoperative complications. In case of surgery aggravating intraoperative factors, particularly in case of perirenal fibrosis, the postoperative complications was diagnosed in 16 (26,6 %) patients, in other cases in 12 (12,25 %) patients (p = 0,0226). 5 (15,63 %) patients died after simultaneous bilateral nefrectomy, and 4 (3,18 %) patients died after the unilateral nefrectomy (p = 0,0002).
The postoperative complications were diagnosed in 11 (26,83 %) of patients, if the nefrectomies were performed with the intent to cure the infection, and in 12 (27,28 %) of patients, if the indication for nefrectomy was nephrolithiasis, in these cases the postoperative complications were more frequent, than in other cases. The vascular dialysis access complications after the nefrectomies due to polycystic renal disease were observed in 10 (20,84 %) patients, and if the nefrectomies were performed due to other reasons, such a complications were observed in 10 (9,09 %) patients (p < 0,05).
Conclusions. The risk of postoperative complications after the nefrectomy in patients undergoing renal replacement therapy is higher in case of surgery aggravating intraoperative factors, particularly in case of perirenal fibrosis. The simultaneous bilateral nefrectomies are associated with higher lethality due to surgery and postoperative complications. The complications risk of nefrectomies in patients with end stage renal disease is higher, if the nefrectomy was performed with the intent to cure the infection or for nephrolithiasis.
January 15, 2015 Accepted:
February 26, 2015