title: Periarterial papaverine improves early postoperative renal function after retroperitoneoscopic partial nephrectomy.
abstract: OBJECTIVE
  To study the impact of periarterial papaverine application on the postoperative glomerular filtration rate (GFR) after retroperitoneoscopic partial nephrectomy (PN).
  
  
  METHODS
  A consecutive series of patients underwent retroperitoneoscopic PN with intraoperative, periarterial application of 50 mg of papaverine. These patients were compared with a group of patients who underwent retroperitoneoscopic PN at this institution prior to this protocol. Patients were matched for preoperative GFR, tumor size, ischemia time, and operative time.
  
  
  RESULTS
  In total, 37 patients who received periarterial papaverine (P) and 37 patients without periarterial papaverine, who served as controls (C), were included in this analysis and matched according to preoperative GFR (P: 98.2, C: 97.8 ml/min/1.72 m(2)), tumor size (P: 2.5 cm, C: 2.5 cm), ischemia time (P: 22 min, C: 23 min), and operative time (P: 86 min, C: 85 min). Postoperative GFR was 86.4 ml/min/1.72 m(2) in controls (C) and 91.8 ml/min/1.72 m(2) in the papaverine group. The pre- to postoperative decrease in GFR was reduced by 56.9% in the papaverine group compared with controls (relative decrease in GFR: P: 5.3% vs. C: 12.5%; P = 0.02). Intra- and postoperative complications were pneumothorax (P: n = 2, C: n = 3), urinary fistula (P: n = 0, C: n = 2), and one suture-fixed drainage (P: n = 1, C: n = 0). No papaverine-related side effects were observed, and the surgical procedure was not hampered by the periarterial application of papaverine.
  
  
  CONCLUSIONS
  As with laparoscopic donor nephrectomy, periarterial papaverine seems to improve postoperative renal function after retroperitoneoscopic partial nephrectomy. This nephroprotective effect might be particularly advantageous for patients with an impaired renal function preoperatively.
authors.affiliation: Department of Urology, Klagenfurt General Hospital, Carinthia, Austria. martin@marszalek.at
authors.forename: Martin
authors.initials: M
authors.lastname: Marszalek
authors.forename: Herbert
authors.initials: H
authors.lastname: Meixl
authors.forename: Claudia
authors.initials: C
authors.lastname: Pitzler
authors.forename: Daniela
authors.initials: D
authors.lastname: Unger
authors.forename: Michael
authors.initials: M
authors.lastname: Rauchenwald
authors.forename: Klaus
authors.initials: K
authors.lastname: Jeschke
authors.forename: Stephan
authors.initials: S
authors.lastname: Madersbacher
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016022:Case-Control Studies; D004305:Dose-Response Relationship, Drug; D005260:Female; D005919:Glomerular Filtration Rate / Q000187:drug effects* / Q000502:physiology; D006801:Humans; D007668:Kidney / Q000187:drug effects / Q000502:physiology*; D007680:Kidney Neoplasms / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy; D061646:Operative Time; D010208:Papaverine / Q000494:pharmacology*; D011184:Postoperative Period; D016896:Treatment Outcome; D064804:Urological Agents / Q000494:pharmacology
chemical_list: D064804:Urological Agents; D010208:Papaverine