Retroperitoneoscopic nephroureterectomy and ipsilateral bladder cuff resection in peritoneal dialysis-dependent patients
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UROLOGY - ORIGINAL PAPER
Retroperitoneoscopic nephroureterectomy and ipsilateral bladder cuff resection in peritoneal dialysis‑dependent patients: tips for immediate reinstitution Han‑Yu Weng1 · Chien‑Hui Ou1 Received: 22 May 2020 / Accepted: 26 June 2020 © Springer Nature B.V. 2020
Abstract Purpose To maximize the chance of maintaining peritoneal dialysis (PD) after retroperitoneoscopic nephroureterectomy without interruption in PD-dependent patients who were suspected as having upper tract urothelial carcinoma (UTUC). Methods During 2005–2018 at our hospital, 10 PD-dependent patients who were suspected as having UTUC underwent hand-assisted retroperitoneoscopic nephroureterectomy (HARN) and bladder cuff resection by a single surgeon. The medical record and post-operative outcomes were retrospectively analyzed. Our surgical tips aiming at staying on PD including keeping adequate but relatively lower insufflation pressure during the operation, reducing the negative pressure of the drain tube post-operatively and initiating PD at a low volume with gradual titration, were also presented in the article. Results A total of ten patients were enrolled in our study. The first five patients failed to resume PD and need interim hemodialysis due to various reasons. After some technique modifications, all the following five patients have PD reinstitution immediately after the operation without increasing the incidence of post-operative complications. Conclusion Staying on PD wound be beneficial for those ESRD patients who underwent retroperitoneoscopic nephroureterectomy due to UTUC, mainly to avoid hemodynamic interference and possible complications related to hemodialysis during the peri-operative period. However, it remains challenging for surgeons. We concluded the key points to minimize peritoneal violation. By adherence to our tips, retroperitoneoscopic nephroureterectomy should be strongly considered in PD patients with suspicious UTUC if feasible. Keywords End-stage-renal-disease · Immediate reinstitution · Peritoneal dialysis · Retroperitoneoscopic nephroureterectomy · Urothelial carcinoma
Introduction Urothelial carcinoma is well known to occur more frequently in patients with end-stage renal disease (ESRD) than in the general population [1]. Although Taiwan has the highest incidence of ESRD in the world, the proportion using peritoneal dialysis (PD) is much lower, at a ratio of 1:9, than that using hemodialysis (HD) compared to the Western countries [2]. Once the surgery is needed, the higher risk of wound complications is always a concern for these
patients [3]. Hence, minimally invasive surgery techniques have been widely used where feasible. In peritoneal dialysis (PD)-dependent patients with ESRD, intraperitoneal surgeries that disturb the peritoneal integrity will inevitably lead to post-operative interim haemodialysis (HD). Here, to maximise the possibility of maintaining PD, we describe our experience with retroperitoneoscopic nephroureterectomy and bladder cuff resection in this patient population
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