Induction of cold ischemia in patients with solitary kidney using retrograde intrarenal cooling: 2-year functional outcomes

Theodore R. Saitz, Philip J. Dorsey, Jan Colli, Benjamin R. Lee

Research output: Contribution to journalArticle

11 Scopus citations

Abstract

Purpose: Renal hypothermia is commonly utilized during nephron sparing surgery to minimize ischemic tissue damage. We propose a method to induce renal hypothermia using continuous retrograde irrigation of iced saline via dual-lumen ureteral catheter. We will report results in an ex vivo porcine model followed by clinical outcomes in a series of patients with solitary kidney undergoing robotic-assisted laparoscopic partial nephrectomy (RALPN). Materials and methods: First, we performed temperature measurements during retrograde renal cooling in a porcine model before investigating the technique in humans. In porcine experiments, renal cortical temperature measurements (n = 270) were recorded during retrograde infusion of ice-cold saline via a 10-Fr dual-lumen ureteral catheter placed in ureter. Subsequently, a series of patients (n = 10) undergoing RALPN with a solitary kidney had concomitant intra-operative retrograde renal cooling. A 10-Fr dual-lumen ureteral catheter was placed at initiation of anesthesia and cold saline initiated prior to renal artery clamping. Results: Porcine cortical temperature reached the target temperature (≤20 C) within an average of 203 s of retrograde irrigation. In the clinical series, patients' mean preoperative creatinine was 1.16 mg/dL (GFR = 60). At a median follow-up of 10 months (range 1-27 months), postoperative creatinine was 1.50 mg/dL (GFR = 41.28). Average clamp time was 19.4 min. All patients had negative surgical margins. Conclusions: Retrograde irrigation is a technically feasible method to induce cold ischemia, which may provide an additional protective effect of renal function in patients who have a solitary kidney undergoing surgery via a minimally invasive approach.

Original languageEnglish (US)
Pages (from-to)313-320
Number of pages8
JournalInternational Urology and Nephrology
Volume45
Issue number2
DOIs
StatePublished - Apr 1 2013
Externally publishedYes

Keywords

  • Cold ischemia
  • Nephron sparing surgery
  • Renal hypothermia
  • Retrograde cooling
  • Solitary kidney

ASJC Scopus subject areas

  • Nephrology
  • Urology

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