Retroperitoneoscopic nephrectomy and nephroureterectomy for benign nonfunctioning kidneys: A single-center experience

Objectives. To report our experience of 185 cases of retroperitoneoscopic n ephrectomy and nephroureterectomy for benign nonfunctioning kidneys with va rious modified techniques for differing etiologies. The feasibility, compli cations, and long-term outcomes are discussed. Methods. The present study comprised 185 patients who underwent retroperito neoscopic nephrectomy or nephroureterectomy during a 57-month period beginn ing July 1995. All procedures were done using the retroperitoneoscopic appr oach. Thirty-two patients had a history of previous surgery, 20 patients ha d a percutaneous nephrostomy, and 12 patients had mild renal impairment. Results. Retroperitoneoscopic nephrectomy and nephroureterectomy were compl eted successfully in 167 patients. Eighteen patients required conversion to open surgery, 4 on an emergent basis and 14 electively. The mean operating time was 100 minutes (range 45 to 240), mean blood loss was 133 mL (range 30 to 1200), and mean hospital stay was 3 days (range 2 to 8). A total of 3 7 complications (16.2% were minor and 3.78% were major) occurred. Re-interv ention was needed in 1 patient. No mortality resulted. Previous surgery, pe rcutaneous nephrostomy, and chronic renal impairment did not affect the out come. Apart from one incisional hernia, no long-term complications occurred . Conclusions. Retroperitoneoscopic nephrectomy and nephroureterectomy can be performed safely and successfully with obvious advantages for benign nonfu nctioning kidneys regardless of the etiology or pathogenesis, with modifica tions in the approach in very difficult cases. Patients with conditions oft en considered to be contraindications (ie, genitourinary tuberculosis, pyon ephrosis, history of previous surgery, percutaneous nephrostomy, stone dise ase, chronic renal failure, and horseshoe kidney) can also be successfully treated by skillful dissection and modifications in the surgical technique. UROLOGY 57: 644-649, 2001. (C) 2001, Elsevier Science Inc.