**4. Conclusion**

Our latest study showed excellent surgical feasibility and cancer-specific survival for NSS in T1b RCC (Joniau et al., 2008). Local cancer control was achieved in the large majority of patients, with preservation of renal function in those with elective indications. NSS is at present the gold standard treatment for renal tumours less than 4 cm. Other studies

The Role of Nephron-Sparing Surgery (NSS) for Renal Tumours >4 cm 345

Funahashi Y., Hattori R. & Yamamoto T. (2009). Ischemic renal damage after Nephron

Gill I., Kavoussi L.,& Lane B. (2007). Comparison of 1800 laparoscopic and open partial

Go A., Chertow G. & Fan D. Chronic kidney disease and the risks of death, cardiovascular

Joniau S, Vander Eeckt K & Srirangam S. (2008) Outcome of nephron-sparing surgery for T1b renal cell carcinoma*, BJU Int*, Vol. 103, No.10 (May 2009), pp.1344-8. Joniau S., Baekelandt F. & Simmons M. (2011) Comparing open versus laparoscopic partial

Kural A., Atug F. &Tufek I. (2009). Robot Assisted partial Nephrectomy versus laparoscopic

Lane B., Fergany A. & Weight C. (2010). Renal functional outcomes after Partial

Lee D., Hruby G. & Benson M. (2010). Renal function and oncologic outcomes in nephron

LeibovitchB., Blute M. &ChevilleJ. (2004).Nephron Sparing Surgery for appropriately

Minervini A., Ficarra V. & Antonelli A.(2011).Simple enucleation is equivalent to Partial

Nemr E, Azar G, Fakih F, et al (2007).Partial Nephrectomy for renal cancers larger than 4 cm,

Nguyen M. & Gill I., (2008). Halving Ischemia Time During Laparoscopic Partial

Patel M., Krane S. & Bhandari A. (2010).Robotic Partial Nephrectomy for Renal Tumors Larger Than 4 cm. *Eur Urol*, Vol. 57 No.2, ( Februari 2010), pp. 310-316 Porpiglia F., Volpe A. &Bilia M. (2006). Assessment of risks factors for complications of laparoscopic partial nephrectomy, *Eur Urol*, Vol.53, No.3 (March 2008) pp. 590-3 Porpiglia F., Fiori C. &Piechaud T. (2010).Laparoscopic partial nephrectomy for large renal

PorpigliaF, Fiori Ch. &Bertolo R., (2010). Does tumor size really affect the safety of laparoscopic partial, nephrectomy, *BJUInt,* Vol.108, No.2, (July 2011), pp. 268-273

Nephrectomy, *J Urol*, Vol. 179, No.2 (Februari 2008), pp. 627-632

Comparative Study, *J Urol,* Vol. 185, No.5,(May 2011), pp. 1604-1610 Margulis V., Tamboli P.&Jacobsohn K., (2007).Oncological efficacy and safety of nephron-

radical nephrectomy, *J Urol*, Vol. 171, No.3, ( March 2004), pp. 1066-1070 Lesage K., Joniau S. & Francis K., (2007).Comparison between open partial and radical

of life, *Eur Urol*, Vol. 51, No.3, (March 2007), pp. 614-620

*BJU ,* Vol.100, No.6, (December 2007), pp.1235-1239

*ProgUrol*, Vol.17, No.4, (June 2007), pp. 810-814

Nephrectomy, *J Urol, Vol.* 184, No.4, (October 2010), pp. 1286-1290

nephrctomy for renal tumors of stage cT1c, in press

No. 1, (January 2009), pp. 209-216

pp.1296-305

2009), pp. 1491-97

(June 2011), pp.343-348

525-529

Sparing Surgery in Patients with Normal Contralateral Kidney, *Eur Urol,*,Vol. 55,

nephrectomies for single renal tumors, *J Urol*, Vol. 178, No. 1, (July 2007), pp. 41-46

events and hospitalization, N Engl J Med , Vol.135, No.13 (September 2004),

Nephrectomy: comparison of Outcomes, *J Endourology*, Vol. 23,No.9 (September

Nephrectomy With Extended Ischemic Intervals are better than after Radical

sparing surgery for renal masses in solitary kidneys, *World J Urol*, Vol. 29, No.3,

selected renal cell Carcinoma between 4 and 7 cm, results in outcome similar to

nephrectomy for renal tumours: perioperative outcome and health-related quality

Nephrectomy for renal cell carcinoma : Results of a nonrandomized, retrospective,

sparing surgery for selected patients with locally advanced renal cell carcinoma,

masses : results of European survey, *World J Urol*,Vol.28, No.4, ( August 2010), pp.

confirmed the feasibility of NSS for tumours of 4 to 7 cm, achieving good oncologic outcomes and preserving kidney function.

The presence of PSM seemed to not have an impact on survival.

Warm ischemia time (WIT) remains a key point. It has to be reduced or avoided as much as possible. If the procedure is suspected to be laborious and WIT lasts more than 25 min, several techniques are useful to help preserve renal function: use of mannitol, cooling …

A laparoscopic approach avoids a painful flank incision but is associated with a longer WIT. Robot assistance joins the minimally invasiveness of the laparoscopic approach with the dexterity of the open NSS. We need longer follow-up before final conclusions can be drawn on oncologic outcomes and renal function preservation of robot-assisted NSS.

In the future, NSS is going to be used for an increasing number of indications. Tumor size does not seems to be a limiting factor anymore. Becker (Becker et al., 2011) already showed the feasibility of NSS even for tumours larger than 7 cm.

#### **5. References**


confirmed the feasibility of NSS for tumours of 4 to 7 cm, achieving good oncologic

Warm ischemia time (WIT) remains a key point. It has to be reduced or avoided as much as possible. If the procedure is suspected to be laborious and WIT lasts more than 25 min, several techniques are useful to help preserve renal function: use of mannitol, cooling …

A laparoscopic approach avoids a painful flank incision but is associated with a longer WIT. Robot assistance joins the minimally invasiveness of the laparoscopic approach with the dexterity of the open NSS. We need longer follow-up before final conclusions can be drawn

In the future, NSS is going to be used for an increasing number of indications. Tumor size does not seems to be a limiting factor anymore. Becker (Becker et al., 2011) already showed

Antonelli A., Cozzoli A. &Nicolai M. (2008).Nephron-sparing surgery versus radical

Becker F., Siemer S. &Hack M. (2006). Excellent Long-term Cancer Control with Elective

Becker F., Van Poppel H. & Hakenberg O W. (2009). Assessing the impact of ischemia time during partial nephrectomy, *EurUrol,*Vol. 56, (Octobre2009),pp. 625-35 Becker F., Roos F. &Janssen M. (2011). Short-term functional and oncologic outcomes of

BensalahK., PantuckAJ. &Rioux-Leclercq N. (2010). Positive Surgical Margin Appears to

Benway BM., Bhayan S. & Rogers CG. (2009). Robot-assisted Partial Nephrectomy for renal

BenwayBM., Bhayani CB. & Rogers CG, (2010). Robot-assisted partial nephrectomy: an

Carini M., Minervini A. & Masieri L. (2006). Simple enucleation for the treatment of PT1a

Carini M., Minervini A. & Lapini A. (2006). Simple enucleation for the treatment of renal cell

Coffin G., Hupertan V. & Taskin L. (2011). Impact of Elective versus Imperative Indications

international experience, *Eur Urol*, Vol. 57, (May 2010), pp. 815-820.

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survival, *J Urol* , Vol. 175 , No.6, ( June 2006) pp.2022-2206

nephrectomy in the treatment of intracapsular renal cell carcinoma up to 7 cm, *Eur* 

Nephron-Sparing Surgery for selected Renal Cell Carcinomas Measuring more than

nephron-sparing surgery for renal tumours larger than 7 cm, *EurUrol*, Vol. 29, (June

have negligible Impact on Survival of Renal Cell Carcinomas treated by Nephron-

tumors: a multi-institutionalanalysis of perioperative outcomes, *J Urol,* Vol. 182,

Renal Cell Carcinoma: our 20-year experience, Vol. 50, (December 2006), pp. 1263-

carcinoma between 4 and 7 cm in greatest dimension: progression and long-term

on Oncologic Outcomes After Open Nephron-Sparing Surgery for the treatment of Sporadic Renal Cell Carcinoma, *Ann Surg Onco,*Vol.18 *(*April 2011)*,* pp. 1151-57

on oncologic outcomes and renal function preservation of robot-assisted NSS.

outcomes and preserving kidney function.

The presence of PSM seemed to not have an impact on survival.

the feasibility of NSS even for tumours larger than 7 cm.

*Urol*, Vol. 53 (April 2008), pp. 803-809

2011),pp. 931-937

68

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4 cm, *Eur Urol,* Vol. 49, (March 2006), pp. 1058-64

**5. References** 


**21**

*Portugal* 

**Benign Prostate Hyperplasia**

**and Chronic Kidney Disease** 

*Urology Department, Centro Hospitalar de Coimbra* 

Ricardo Leão, Bruno Jorge Pereira and Hugo Coelho

Benign Prostate Hyperplasia (BPH) is a common disease in adult men and its incidence is age related. On the basis of clinical criteria, the Baltimore Longitudinal Study of Aging found that the prevalence of BPH is approximately 25% in men aged 40 to 49 years, 50% in men aged 50 to 59 years, and 80% in men aged 70 to 79 years (Arrighi, Metter et al. 1991).

BHP is theoretically the detection of prostatic hyperplasia, which is the benign proliferation of the stroma and epithelium, by histological study. However histological studies for all men are unfeasible in clinical practice, so BHP usually refers to the palpable enlargement of the prostate, which can be detected by clinical or ultrasonographic examination, or presence of urinary symptoms loosely defined as lower urinary tract symptoms (LUTS), which are

Chronic kidney disease (CKD) encompasses a spectrum of different pathophysiologic processes associated with abnormal kidney function, and a progressive decline in glomerular filtration rate (GFR). *Chronic renal failure* (CRF) applies to the process of continuing significant irreversible reduction in nephron number, *end-stage renal disease* (ESRD) represents a stage of CKD where the accumulation of toxins, fluid, and electrolytes normally excreted by the kidneys results in the *uremic syndrome*. This syndrome leads to death unless the toxins are removed by renal replacement therapy, using dialysis or kidney transplantation (Fauci 2007). The prevalence of CRF using the Modification of Diet in Renal Disease equation is 26% in adults who are 70 years and older. Men are at 67% greater risk for advanced chronic renal failure and at 44% greater risk for end stage renal disease than

Despite the many possible causes of obstructive uropathy, in studies of elderly patients with acute renal failure, the most common cause among all patients was BPH (Kumar, Hill et al. 1973; Tseng and Stoller 2009). Kumar et al., showed in their studies that acute renal failure in patients with obstructive uropathy were due to BPH (38%), neurogenic bladder (19%),

Attending to high prevalence of BPH in older men with CKD it is invaluable to take into consideration the relationship between these two clinical entities. However, despite the high prevalence of CKD and BPH in elderly men, there is limited knowledge on the association

usually classified as obstructive or irritative (Levy and Samraj 2007).

**1. Introduction** 

women (Rule, Lieber et al. 2005).

obstructive pyelonephritis (15%).

between these two conditions.

