STUDY ON THE METHOD OF RENAL PARENCHYMAL SUTURE IN NEPHROLITHOTOMY

PART II: CLINICAL OBSERVATIONS ON THE CHANGES OF RENAL VASCULAR PATTERN IN ONE LAYER INTERRUPTED SUTURE

Abstract

The author made a study on the renal vascular pattern and the renal function before and after operation of staghorn calculi or multiple large calculi in 17 kidneys of 16 patients.
The cases were divided into the following 2 groups. Group I (14 kidneys of 13 patients) were subjected nephrolithotomy. Group II (3 kidneys of 3 patients) were subjected to partial nephrectomy.
In nephrolithotomy, closure of the renal parenchymal incision was made with one layer interrupted suture from pelvic mucosa to renal capsule by 2-0 plain cat gut. This method was originally designed by Dr. Taguchi in 1967 and he had performed the operation by this method in about 50 cases with good result.
Renal angiography was performed in 12 kidneys of Group I and 2 kidneys of Group II.
The renal function was assessed by BUN, serum creatinine, PSP test, Fishberg's concentration, renal clearance (24-hour creatinine clearance), excretory urography and isotope renogram.
The following conclusions were obtained.
1. The average duration of renal artery clamp time of Group I was 16 minutes and 14 seconds and shorter than that of Group II.
2. Preoperative angiograms were classified into 3 patterns. They were compatible with normal, pyelonephritis and hydronephrosis.
3. Postoperative angiograms of Group I showed the interruption of interlobar arteries in 91.7 per cent of kidneys. Cortical infarction due to arterial interruption was seen in 66.7 per cent of kidneys but the mean residual area of nephrogram in these 8 kidneys was 93.6 per cent of that found in the preoperative examination. The mean diameter of the renal main artery was 87.5 per cent of that found in the preoperative angiograms and arterio-venous fistula was proved in one case without any circulatory complications.
4. Renal function of Group I has improved or remained stable postoperatively in all but 2 patients whose isotope renogram was slightly deteriorated.
5. In Group II, there were arterial spasm in residual renal parenchyma and the mean diameter of the renal main artery was 69.0 per cent of that found in the preoperative studies.
6. Renal function of Group II by excretory urography and isotope renogram showed a reduction in 66.6 per cent of kidneys but the other function tests remained unchanged.
7. Despite the limited number of cases treated and the short period of follow-up, it is considered that the parenchymal loss and arterial damage are of little importance in nephrolithotomy with one layer interrupted suture. This result was due to the short arterial clamp time and harmlessness of parenchymal suture.