Optimising patients with long-term spinal cord injury for nephrectomy: A review of pre-, peri- and post-operative factors to safeguard outcomes (2020)

Type of publication:
Journal article

Author(s):
*Donati-Bourne J.; *Mohamed W.G.E.; *Pillai P.; *O’Dair J.; Kasmani Z.; Bhatt R.I.

Citation:
Journal of Clinical Urology; 2020 [epub ahead of print]

Abstract:
Objectives: To review the potential challenges a urologist may encounter when embarking on simple/partial/radical nephrectomy in patients with long-term spinal cord injury and propose strategies to pre-empt and manage these.
Material(s) and Method(s): Comprehensive literature review via PubMed, MEDLINE and Google Scholar
searching for relevant scientific articles published to date in English. Recommendations for strategies to safeguard surgical outcomes discussed with a panel of experienced upper-tract urologists.
Result(s): Pre-operative considerations: – urethral assessment via flexible cystoscopy due to higher incidence of urethral pathology in spinal cord injury; – assessing for chronic constipation and distended bowel; and – considering glomerular filtration rate assessment by radio-isotope techniques, such as 51chromium-EDTA Perioperative considerations: – adequate theatre staffing for safe patient transfer; and – planned choice of incision, due to higher incidence of previous abdominal surgery, stoma bags and/or foreign body devices. Post-operative considerations: – ensuring attending medical staff are trained to recognise autonomic dysreflexia; – early remobilisation with physiotherapists experienced in treating spinal cord injury; and – attentive antibiotic stewardship due to higher risk of hospital-acquired or urinary infections
Conclusion(s): Patients with long-term spinal cord injury pose significant potential challenges in the pre-, periand post-operative stages of nephrectomy. Familiarisation and optimisation of such factors is recommended to safeguard outcomes.
Level of Evidence: Not applicable for this multicentre audit.

Current trends in cytoreductive nephrectomy in the era of targeted molecular therapy (2017)

Type of publication:
Conference abstract

Author(s):
*Phan Y.; *Segaran S.; *Bell J.; *Nakada S.Y.; *Rane A.

Citation:
Journal of Endourology; Sep 2017; vol. 31, S2

Abstract:
Introduction & Objective: Several factors are considered when determining if a patient is a candidate for
cytoreductive nephrectomy (CN). Our aim was to study geographic trends and factors associated with the decision to consider CN. Materials and Methods: An investigator designed survey was created to assess the rate of CN being performed around the world and the factors considered when determining patient eligibility. This was distributed to attendees at the World Congress of Endourology 2016 in Cape Town in order to capture an international cohort of urologists. The survey included questions about physician demographics, the timing of CN, what patient factors were considered prior performing CN, and if they followed any guidelines when deciding on CN. Results: 158 urologists responded to our survey (Asia = 46, Europe = 35, Africa = 34, North America = 29, South America = 13 and Australia = 1). 78 (49.4%) urologists indicated that they follow guidelines for recommending CN. 107 (67.7%) of respondents stated they perform CN. 64 urologists perform CN prior to systemic therapy while 20 urologists perform CN after systemic treatment, and 22 urologists perform CN before or after systemic treatment. Performance status was the most considered factor while calcium level was the least considered factor when determining eligibility for CN. Conclusions: This cohort of urologists most commonly consider performance status, age and extent of metastatic disease when determining candidacy for CN; while the grade of the tumour and the calcium level were the least considered. We eagerly await the results of CARMENA and SURTIME trials.