RAMAYYA PRAMILA HOSPITAL PERFORMS FIVE NEPHRECTOMIES IN A WEEK

We performed a total five nephrectomies this week.

1)Case of non- functioning kidney because of Pelvi-Ureteric Junction obstruction.A child of 9 years came with pain in left  flank  and on investigation was found to have NFK(DTPA renogram- void area).

He was taken up for left Laparoscopic nephrectomy.The approach was transperitoneal with three ports in place.The procedure was done uneventfully and the patient was discharged after 48 hours postoperatively.

2) Xanthogranulomatous kidney: A 80 year old lady came with recurrent fever and right flank pain.

On investigation was found to have large renal pelvic calculi with non functioning kidney.Because of her age and CT scan showing large pus pockets and severe perinephric stranding ; we safely resorted  to open nephrectomy.We found dense perinephric adhesions and could do subcapsular nephrectomy.The patient had ESBL MDR bacteria and hence was started preoperatively on colistin and sulbactam combination.The fever did not abate even after the surgery and the patient started getting diarrhea.Her counts were raised to 20,000/cmm and the procalcitonin levels were more than 100 units.We added Daptomycin antibiotic therapy.Subsequently the patient recovered.

3) Pyonephrotic kidney: A 53 year old lady came to us with fever and large tender right kidney( there was history of multiple urological interventions in the past like ESWL,PCNL).She was septicemic with polymorpho leucocytosis.

We did urgent right PERCUTANEOUS NEPHROSTOMY.It drained 500 ml pus instantly.The pus grew MDR klebsiella and hence was started on MEROPENAM 1 gm IV TID and was taken up for laparoscopic nephrectomy after 1 week of the PCN.The approach was transperitoneal with four ports.The nephrectomy was as anticipated difficult with perinephreic adhesions.The patinet recovered unevetfully after the surgery.

4)We did right nephrectomy(open) for a patient of ADPKD with End Stage Kidney Disease on Maintenance HD.A 50 year gentleman a known case of ADPKD came with abdominal distension, pain and  respiratory distress because of mas effect from the phenomenally large  kidneys.He was end stage renal disease on maintenance dialysis. 

He was referred to our centre for nephrectomy of a symptomatic kidney.The patient was considered for open nephrectomy as we thought laparoscopic nephrectomy would be difficult for want of space in the abdomen.The other option of renal angioembolisation was also not preferred for the fear of postinfarction sequel  and there was a consensus that the removal of renal mass would only be the best relief for distension and the respiratory distress because of the mass.

The both kidneys were 28 cm (left) and 22 cm( right ) respectively.He was symptomatic on the right side so we preferred for right nephrectomy.

The rooftop incision was given and the colon was reflected .The right kidney was huge and was crossing the midline over the great vessels.The lower part of the kidney was solid ( haemorrhagic cyst).The kidney was mobilised all around and the hilum was secured and renal mass was removed.

We went for marsupialisation also on left side for two prominent cysts at the same time( around 6 cm each two cysts).

5).A 30 year old young gentleman came with pain in left flank.On investigation; he was found to have left lower polar mass.On CECT ; there was heterogeneous enhancing cystic mass in the lower pole encroaching till the hilum.There was perinephric stranding.
We took the patient for left Radical nephrectomy (Laparoscopic nephrectomy).The approach was trans-peritoneal with three port.The colon was reflected and the kidney was mobilised outside the Gerotas Fascia.The hilum was secured and cut with Hem-o-Lock clips ( artery followed by renal vein).The specimen was retrieved after the camera port site was extended by 3 inches more.