title: Acute Renal Failure Secondary to Rhabdomyolysis as a Complication of Major Urological Surgery: The Experience of a High-Volume Urological Center.
abstract: OBJECTIVE
  The aim of this study was to determine the incidence of acute renal failure secondary to rhabdomyolysis (ARFSR) as a complication of major urological surgery (MUS), as well as to describe the clinical characteristics and identify possible risk and protective factors.
  
  
  METHODS
  Cases of ARFSR due to MUS between January 1997 and August 2011 were identified using the institutional database. The incidence was estimated and the clinical characteristics were analyzed using simple scatterplot graphs to identify possible risk and protective factors.
  
  
  RESULTS
  In this period, 14,337 MUS procedures were performed, in which 4 cases suffered from ARFSR (the incidence rate was 0.03%). The incidence rates after radical cystectomy and urethroplasty were 0.26% (3/1,175 cases) and 0.15% (1/651 cases), respectively. No case of rhabdomyolysis was reported among the patients who underwent other major surgical procedures. Two patients required dialysis, and all 4 patients recovered to their baseline renal function at an average of 11 days (7-17) with the appropriate treatment. Male gender, younger age, lower ASA score, prolonged operative time, high body mass index, elevated preoperative serum creatinine and estimated blood loss were possible risk factors for developing ARFSR due to MUS. We found that a higher intraoperative administered volume was a possible protective factor. The operative position and type of surgery seemed to play minor roles. Early diagnosis and treatment possibly leads to an improved outcome.
  
  
  CONCLUSIONS
  In our study, ARFSR due to MUS was a rare entity and had a good prognosis. It was more frequent as a complication of radical cystectomy. Further studies are required to confirm our findings.
authors.affiliation: Department of Urology, Fundacix00F3; Puigvert, Barcelona, Spain.
authors.forename: Armando E
authors.initials: AE
authors.lastname: De Gracia-Nieto
authors.forename: Oriol
authors.initials: O
authors.lastname: Angerri
authors.forename: Jordi
authors.initials: J
authors.lastname: Bover
authors.forename: Daniel
authors.initials: D
authors.lastname: Salas
authors.forename: Juan Manuel
authors.initials: JM
authors.lastname: Villamizar
authors.forename: Humberto
authors.initials: H
authors.lastname: Villavicencio
mesh_terms: D058186:Acute Kidney Injury / Q000209:etiology*; D000328:Adult; D017677:Age Distribution; D000368:Aged; D016063:Blood Loss, Surgical; D005260:Female; D061847:Hospitals, High-Volume; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D011183:Postoperative Complications / Q000453:epidemiology*; D012189:Retrospective Studies; D012206:Rhabdomyolysis / Q000150:complications* / Q000209:etiology*; D012307:Risk Factors; D063507:Sexism; D013520:Urologic Surgical Procedures / Q000009:adverse effects*