Which Stage of ADPKD Is More Appropriate for Decortication? A Retrospective Study of 137 Patients from a Single Clinic.
OBJECTIVE
To study retrospectively the efficacy of decortication in patients with different stages of ADPKD and to determine which stage for decortication is more appropriate.


METHODS
We analyzed 137 patients with ADPKD from 2001 to 2010. All patients were divided into three stages. A total of 70 patients underwent decortication, and we studied intraoperative indicators and postoperative indicators at 1 and 3 years follow-up.


RESULTS
In 70 patients who underwent decortication, significant differences were observed in operative duration and bleeding volume between patients with stage I and II ADPKD (P<0.05), but no significant differences were observed in intestinal recovery time, pain medication dose, and the days of postoperative hospitalization (P > 0.05). The total complication occurrence rate was significantly different between them (P < 0.05). The serum creatinine (Scr) levels in patients with stage I ADPKD were within normal limits 1 and 3 years postoperatively and did not differ significantly (P > 0.05). Scr levels were significantly decreased in patients with stage II ADPKD in the 1st postoperative year (P < 0.05), but these were not significant differences in the 3rd postoperative year (P > 0.05). In the 1st postoperative year, VAS value, blood pressure and renal volume significantly differed (P < 0.05). However, no significant differences were observed 3 years later (P > 0.05).


CONCLUSIONS
Decortication in patients with stage I ADPKD can alleviate back pain symptoms and decrease blood pressure within 1 year, but the long-term efficacy is not ideal. Scr levels can be maintained within normal limits, suggesting that decortication does not lead to deterioration of renal function. For patients with stage II ADPKD, decortication can significantly improve renal function over the short term. However, after 3 years, renal function returns to the preoperative level, and surgical difficulties and complications also increase.
Department of Urology, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.
Xiaoqiang
X
Qian
Department of Urology, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.
Xujun
X
Sheng
Department of Urology, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.
Ruipeng
R
Li
Department of Urology, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.
Hailong
H
Liu
Department of Urology, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.
Xiangjie
X
Kong
Department of Urology, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.
Liujian
L
Duan
Department of Urology, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.
Jun
J
Qi
D000328:Adult; D005260:Female; D006801:Humans; D007672:Kidney Cortex / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D019990:Perioperative Care; D016891:Polycystic Kidney, Autosomal Dominant / Q000601:surgery*; D011183:Postoperative Complications / Q000209:etiology; D012189:Retrospective Studies; D016896:Treatment Outcome