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Wyniki leczenia operacyjnego raka nerki w I Klinice Urologii Uniwersytetu Medycznego w Łodzi w latach 2004–2010

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Kierstan A., Jabłonowski Z., Sosnowski M.
Folia Medica Lodziensia
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2016
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vol. 43
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issue 1
53-68
EN
Introduction. Aim of the study: The only effective treatment method for all forms of the kidney cancer is surgery with possible subsequent institution of neoadjuvant treatment. The standard management involves nephrectomy with or without lymphadenectomy and adrenalectomy. In patients with kidney tumors up to 4 cm in diameter, surgical procedures saving the renal parenchyma (Nephron-Sparing Surgery – NSS) are currently performed. The objective was the retrospective analysis of the treatment results obtained in renal cancer patients who had undergone surgical procedures. The results of the treatment following nephrectomy performed from transperitoneal and retroperitoneal approach were compared with those obtained after NSS type procedures. Material and methods: The study was carried out in 238 patients: 107 women and 131 men with kidney cancer, operated on in the years 2004 – 2010. In 15 patients distant metastases were found. The nephrectomy was performed in 69 patients from transperitoneal access and in 105 patients from retroperitoneal access with NSS procedures in 55 patients. The transperitoneal approach was used in patients with large tumors ranging > 6 cm size. Other patients were operated on with lumbar access, also those with tumors < 4 cm, since that approach was used for NSS procedures. The intraoperative and postoperative period, the duration of the surgery, complications, hospitalization time, analgesic treatment and overall survival were evaluated. Results: The operated patients were hospitalized for 11 days on the average, and the mean time of the surgical procedure was ca. 168 minutes. Intraoperative blood loss during most of the performed procedures was without clinical significance but the largest blood loss during the operation was reported in the patients with kidney tumors > 10 cm during transperitoneal access surgery. The blood loss was compensated in 33 cases by the administration of RBC preparations in 21.74% of the patients after transperitoneal access surgeries and 10.65% of those after lumbar access. Retroperitoneal access was associated with the use of larger quantities of analgesic medications in the postoperative period. Histopathological investigations resulted with clear cell carcinoma in 85% of the patients, in other 15% of the cases, most commonly diagnosed with chromophobe and papillary carcinomas. The malignancy grade of RCC according to Fuhrman scale; Fuhrman 1 – 7.98%, Fuhrman 2 – 61.38%, Fuhrman 3 – 9.66%, Fuhrman 4 – 5.88%. Fuhrman grades 3 and 4 were, however, more common in the patients with the big tumors undergoing transperitoneal access. The local advancement of the removed kidney tumors according to TNM classification: stage pT1 in 156 patients, stage pT2 in 52 and pT3 in 1 patient. The distribution of diagnoses and staging was similar for both surgical approaches. The results of kidney cancer treatment were reflected by the assessment of 5–year survival of the patients. Such analysis was possible only in the subgroup of 115 patients who had undergone the surgery in the years 2004 – 2007. The obtained data indicated the overall 5–year survival rate amounting to 58.3% of the reviewed subgroup, whereas 48 patients, i.e. 41.7% died. The causes of death were not possible to know. It is noteworthy that the group of deaths included all the patients operated on at the metastatic stage of the disease. Conclusions: In large renal tumors > 6 cm size, transperitoneal access nephrectomy was preferred. In the remaining patients lumbar access procedures were performed, including kidney-sparing surgery. Fuhrman grade 3 and 4 clear cell tumors are predominant in the patients operated on with transperitoneal access. The number of intra- and postoperative complications is similar in both groups. The use of transperitoneal access is associated with an increase in the amount of analgesics administered in the postoperative course, longer duration of the surgical procedure and longer hospitalization time. The overall 5–year survival rate for the group of 115 patients operated on in the years 2004–2007 was 58.3%.
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Distant 10 years results of laparoscopic operative treatment in patients with varicocele

88%
Jabłonowski Z., Grzegorczyk A., Kȩdzierski R., Miȩkoś E., Sosnowski M.
Open Medicine
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2009
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vol. 4
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issue 2
203-207
EN
Varicocele has been regarded a curable cause of infertility for dozens of years. The impact of varicocele treatment in terms of increase in pregnancy rates is a debated issue. We evaluate data from a 10-year cohort of results from laparoscopic operative treatment of varicocele patients according to pregnancy rate, complication rate, and satisfaction with varicocele repair. Ninety seven patients were treated by means of laparoscopy between 1993 and 1996. Ten years after operation questionnaires were sent to all patients. Answers were obtained from 49/97 pts. (50,5%). Details connected with marital status, pregnancy rate, addictions and scrotal pain discomfort were collected. Statistical analysis was performed using chi-square independence test and Spearman’s rank correlation coefficient. After 10 years, 75.5% who answered the questionnaire were fully satisfied with the results of treatment, 12.3% pts of patients were partially satisfied; 63.3% of patients fathered 1 to 3 children. Married patients and those who fathered children were found to be the most satisfied with the operation. We also found the statistically significant negative dependency between smoking addiction and number of children. There were no major complications intra- or postoperatively. No harmful consequences of testicular artery ligation were found. In conclusion, long-time 10 years follow-up enables better estimation of the results of laparoscopic treatment in patients with varicocele. Pregnancy rate may depend not only on varicocele repair but on smoking addiction as well. There is still no evidence of harmful consequences due to testicular artery ligation after varicocele repair
3
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Total serum testosterone estimation and ultrasonographic volumetric evaluation of testes in patients with alcoholic liver cirrhosis

76%
Jabłonowski Z., Kuydowicz J., Sosnowski M., Różański W., Jabłośki S., Jabłonowska E.
Open Medicine
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2009
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vol. 4
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issue 3
299-303
EN
In the course of cirrhosis, a variety of disturbances of endocrine glands occur. Degenerative changes in the testes with atrophia and fibrosis of the glandular tissue are often found in men. Twenty-one males with compensated alcoholic liver cirrhosis were studied. The age ranged from 29 to 61 years (mean 47,1). Efficiency of the liver was evaluated according to Child classification. HBC (this needs to be spelled out in parenthesis) or HBV (Hepatitis B Virus) infections were excluded. Levels of serum testosterone were determined and the volume size of the testes was measured using 7,5 MHz sector probe, B&K Medical ultrasonograph, 3535 model. Volume size of the testes was measured in 22 healthy control volunteers, as well; age ranged from 25 to 66 years (mean-46,6). All patients were interviewed about sexual function, particularly possible erectile dysfunction using IIEF-5 questionnaire. The mean testosterone level was 8,89 umol/l (ranged: 7,4–10,9 umol/l) in the study patients [the normal range interval: 8,2–34,6 umol/l]. The level was below the normal range in 4 patients, and low but within the normal range in the remaining patients. Statistically significant lower values of both testes volumes were estimated in patients with compensated alcoholic liver cirrhosis in comparison to healthy controls (p<0,001), however only 5 (23,81 %) study group subjects admitted impaired libido and erectile dysfunction. Decreased levels of testosterone in the peripheral blood and diminished volume size of testes are found in patients suffering from alcoholic liver cirrhosis. Erectile dysfunction in patients with liver cirrhosis needs further evaluation.
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