title: Induction of cold ischemia in patients with solitary kidney using retrograde intrarenal cooling: 2-year functional outcomes.
abstract: OBJECTIVE
  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).
  
  
  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.
authors: Department of Urology, Tulane University School of Medicine, 1430 Tulane Avenue, SL-42, Room 3522, New Orleans, LA 70112, USA.
authors: Theodore R
authors: TR
authors: Saitz
authors: Philip J
authors: PJ
authors: Dorsey
authors: Jan
authors: J
authors: Colli
authors: Benjamin R
authors: BR
authors: Lee
mesh_terms: D000818:Animals; D002292:Carcinoma, Renal Cell / Q000150:complications / Q000601:surgery; D050377:Cold Ischemia; D005260:Female; D006801:Humans; D007036:Hypothermia, Induced; D007668:Kidney / Q000002:abnormalities; D007680:Kidney Neoplasms / Q000150:complications / Q000601:surgery; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000379:methods*; D012371:Robotics; D013552:Swine
references: J Urol. 2004 Jan;171(1):68-71
references: 14665846
references: Br J Urol. 1975 Feb;47(1):17-24
references: 236801
references: J Urol. 2011 Jan;185(1):43-8
references: 21074205
references: BJU Int. 2007 Jan;99(1):166-70
references: 17094782
references: Eur Urol. 2007 Oct;52(4):1170-8
references: 17445978
references: BJU Int. 2005 May;95(7):948-50
references: 15839910
references: J Urol. 2010 Nov;184(5):1861-6
references: 20846690
references: J Urol. 2010 Feb;183(2):473-9
references: 20006866
references: Eur Urol. 2009 Oct;56(4):625-34
references: 19656615
references: J Urol. 2007 Jul;178(1):41-6
references: 17574056
references: Urology. 2005 Jul;66(1):33-7
references: 15992883
references: J Urol. 2009 Oct;182(4):1271-9
references: 19683266
references: Urology. 2003 May;61(5):1023-5
references: 12736030
references: J Urol. 2007 Feb;177(2):471-6
references: 17222613
references: Eur Urol. 2010 Sep;58(3):331-6
references: 20557996
references: Urology. 2008 Sep;72(3):687-9
references: 18374397
references: Urology. 2007 Mar;69(3):465-8
references: 17382146
references: J Urol. 2005 Jul;174(1):350-2
references: 15947688
references: J Natl Compr Canc Netw. 2009 Jun;7(6):618-30
references: 19555584
references: J Urol. 2003 Jul;170(1):52-6
references: 12796643
references: Eur Urol. 2010 Sep;58(3):340-5
references: 20825756
references: Nat Clin Pract Urol. 2006 Apr;3(4):198-205
references: 16607368