TITLE:
Assessment of Warm and Cold Ischemia on Functions of the Operated Kidney with 99mTc-DMSA in Renal Masses: A Prospective and Randomized Study
AUTHORS:
Abdullah Demirtas, Numan Baydilli, Nurettin Sahin, Oguz Ekmekcioglu, Deniz Demirci, Atila Tatlisen
KEYWORDS:
Cold Ischemia Times; Nephron Sparing Surgery; Renal Cancer; Technetium-99m-Dimercaptosuccinic Acid; Warm Ischemia Times
JOURNAL NAME:
Open Journal of Urology,
Vol.3 No.2,
May
15,
2013
ABSTRACT: Objective: To examine the effect of warm and cold ischemia on functions of the
operated kidney in cases with a normal contralateral kidney undergoing nephron
sparing surgery. Methods: This study enrolled 40 patients with a normal contralateral kidney
and without a renal function threatening risk factor, who were operated with
NSS. The patients were randomized at admission. They were divided into 2 equal
groups as warm and cold ischemia. An ice application for 10 minutes was done to
cold ischemia group after clamping renal artery. Renal functions were evaluated
with Technesium-99m-Dimercaptosuccinic
Acid (DMSA) and serum creatinine at the preoperative and postoperative (day 1,
day 15, month 6, and month 12) period. Statistical analysis was done with Mann
Whitney U test, Wilcoxon Signed Rank test, and Fredman test. A p value below
0.05 was considered statistically significant. Results: There were no significant differences
between the groups in terms of age, body mass index, ischemia time, tumor size,
amount of hemorrhage, and procedure time. Both groups had a significantly
higher DMSA uptake at the preoperative period compared with the postoperative
period (postoperative day 1, day 15, month 6, and month 12) (p 0.001).
However, both groups had similar DMSA uptake results at the postoperative
period. Preoperative and postoperative creatinine levels were not significantly
different from each other in both groups. Conclusion: Based on tumor localization,
nephron sparing surgery without use of superficial cooling appears as a viable
option for small renal masses.