A STUDY OF PARTIAL NEPHRECTOMY 7TH REPORT

FOLLOW UP RESULTS OF CLINICAL CASES AND AN EXPERIMENTAL STUDY OF PARTIAL NEPHRECTOMY ON THE DENERVATED KIDNEY

Abstract

I. Follow up study of partial nephrectomy
From 1950 up to date, partial nephrectomy have been performed 117 times on 115 kidneys, 61 cases of renal calculi, 35 of renal tuberculosis, 11 of renal bleeding and 8 of hydronephrosis.
Age: From 16 to 65 years of age.
Sex: 85 males and 30 females.
Operative results are following: 97 cases were cured, 54 of renal calculi, 27 of renal tuberculosis, 8 of renal bleeding and 8 of hydronephrosis.
2 cases died, one of these due to postoperative hemorrhage in a case of renal calculus, and to tuberculous meningitis in another case.
Secondary nephrectomy was performed on 14 cases, 10 for postoperative hemorrhage, 3 for tuberculosis of remaining kidney and one for continuous urinary fistula.
Excellent results have been obtained since September 1954, owing to a new operative technique.
Now partial nephrectomy is a safe urologic operation for us.
II. Experimental study of renal circulation following partial nephrectomy on the denervatedd kidney
Material: 57 dogs of body weight 6-13Kg.
Method: Following periarterial denervation or periarterial injection of pendiomide, partial nephrectomy was performed on the lower pol of the left kidney. Postoperative renal circulatory study utilizing abdominal aortogram (31 dogs) and Indian ink injection (26 dogs) were done at the interval of 2 hour, 1 day, 2 days, 3 days, 4 days and 1 week. And results were comparedd with that of the innervated kidneys.
The results were as follows:
(A) Changes of the renal artery
In the denervated kidneys the renal arteries that have been pinched with clamps for 10 minutes during the resection look very small immediately after the operation. However, the constriction of the renal artery is rapidly restored to regain its normal diameter from the 3rd to 4th postoperative days. Intrarenal arteries were recognized more clearly than the right kidney, and normal findings were obtained from 3rd to 4th postoperatively.
On the other hand, in the innervated kidneys, constriction of the renal artery and intrarenal arteries was severe, especially intrarenal arteries of the operated kidneys were scarcely possible to observe, and its recovery required 7 to 10 days in the same experiment.
(B) Changes of the renal circulation
The renal circulation was examined by looking at the distribution of the concentration of Indian ink and histologically by looking at the kidney of dogs injected with Indian ink 2 hours to 1 week after the partial nephrectomy.
On the denervated Kidney, the change is slight, that is, Indian ink slightly decreased in cortex, and slightly increased in medulla and retured to normal findings within 4 to 7 days,
On the innervated kidney, Trueta's renal vascular shunt-like change, that is, marked cortical ishemia and marked increase of Indian ink in medulla were observed. Recovery was very slow, and it required more than 7 days to return to normal state.
Microscopic findings is same to macroscopic findings,
In the denervated kindey, the cortical ischemia after partial nephrectomy is of less degree than innervated kidney, and its recovery is rapid.