Perioperative outcomes and risk factors for major complications associated with nephrectomy for Xanthogranulomatous pyelonephritis: a multicenter study.

Autor: Robles-Torres JI; Hospital Universitario 'Dr. José Eleuterio, González', Monterrey, Nuevo León, Mexico. Ivan.robles25@live.com., García-Chairez LR; Hospital Universitario 'Dr. José Eleuterio, González', Monterrey, Nuevo León, Mexico., Castellani D; Urology Unit Azienda Ospedaliero-Universitaria Delle Marche, Ancona, Italy., Enrriquez-Ávila JV; Hospital Universitario 'Dr. José Eleuterio, González', Monterrey, Nuevo León, Mexico., Monzón-Falconi JF; Hospital Regional de Alta Especialidad de La Penisula de Yucatán, Mérida, Mexico., Esqueda-Mendoza A; Hospital Regional de Alta Especialidad de La Penisula de Yucatán, Mérida, Mexico., Flores-Tapia JP; Hospital Regional de Alta Especialidad de La Penisula de Yucatán, Mérida, Mexico., Wroclawski ML; Faculdade de Medicina Do ABC, Santo André, São Paulo, SP, Brazil.; BP - a Beneficência Postuguesa de São Paulo, São Paulo, SP, Brazil., Duarte-Santos HO; Hospital Municipal Moysés Deutsch, São Paulo, SP, Brazil., Ragoori D; Asian Institute of Nephrology and Urology, Hyderabad, Telangana, India., Gadzhiev N; Saint Petersburg State University Hospital, St. Petersburg, Russia., Mahajan A; Mahatma Gandhi Mission's Medical College and Hospital, Aurangabad, India., Kumar S; Department Urology, Christian Medical College, Vellore, Tamil Nadu, India., Farooq M; Department Urology, Christian Medical College, Vellore, Tamil Nadu, India., Ganpule A; Department of Urology, Muljibhai Patel Urological Hospital, Nadiad, Gujarat, India., Tanidir Y; Department of Urology, Marmara University School of Medicine, Istanbul, Turkey., Maheshwari PN; Fortis Hospital Mulund, Mumbai, India., Gite VA; Grant Medical College and Sir JJ Hospital, Mumbai, India., Sinha MM; University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton, SO16 6YD, UK., Somani BK; University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton, SO16 6YD, UK., Gutiérrez-González A; Hospital Universitario 'Dr. José Eleuterio, González', Monterrey, Nuevo León, Mexico., Gauhar V; Ng Teng Fong General Hospital (NTFGH)/NUHS, Singapore, Singapore.
Jazyk: angličtina
Zdroj: World journal of urology [World J Urol] 2023 Nov; Vol. 41 (11), pp. 2905-2914. Date of Electronic Publication: 2023 May 12.
DOI: 10.1007/s00345-023-04415-x
Abstrakt: Purpose: To determine the risk factors associated with major complications in patients with histologically confirmed Xanthogranulomatous pyelonephritis (XGP) who underwent nephrectomy.
Methods: A multicenter retrospective study was performed including patients who underwent nephrectomy between 2018 and 2022 with histopathological diagnosis of XGP. Clinical and laboratory parameters at the initial presentation were evaluated. Data on extension of XGP was recorded as per the Malek clinical-radiological classification. Characteristics of nephrectomy and perioperative outcomes were obtained. The primary outcome was major complications, defined as a CD ≥ grade 3 and the need for intensive care unit (ICU) admission. Secondary outcomes included the comparison of complications evaluating the nephrectomy approach (transperitoneal, retroperitoneal, and laparoscopic). A sub-analysis stratifying patients who needed ICU admission and Malek classification was performed.
Results: A total of 403 patients from 10 centers were included. Major complications were reported in 98 cases (24.3%), and organ injuries were reported in 58 patients (14.4%), being vascular injuries the most frequent (6.2%). Mortality was reported in 5 cases (1.2%). A quick Sepsis-related Organ Failure Assessment (qSOFA) score ≥ 2, increased creatinine, paranephric extension of disease (Malek stage 3), a positive urine culture, and retroperitoneal approach were independent factors associated with major complications.
Conclusion: Counseling patients on factors associated with higher surgical complications is quintessential when managing this disease. Clinical-radiological staging, such as the Malek classification may predict the risk of major complications in patients with XGP who will undergo nephrectomy. A transperitoneal open approach may be the next best option when laparoscopic approach is not feasible.
(© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)
Databáze: MEDLINE
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