Three-dimensional kidney models and percutaneous transvesical ureteral stenting aided successful bilateral partial nephrectomy for highly complex bilateral renal cell carcinoma: A case report

Abstract

A 54-year-old male presented with gross hematuria. Ultrasonography and computed tomography (CT) revealed a right kidney tumor of 68 mm and another left kidney tumor of 64 mm in diameter. Contrast-enhanced CT findings were suggestive of bilateral renal cell carcinoma (right cT1b/left cT1bN0M0). Their R.E.N.A.L. nephrometry scores were 10 and 9 points for the right and the left kidney, respectively. We developed three-dimensional (3D) kidney models to simulate open partial nephrectomy (PN) preoperatively. According to the simulations, we planned two stage PNs with selective blood vessel dissection and urinary stenting due to the high possibility of postoperative urinary leakage. Firstly, we performed left PN with a 7-minute long renovascular clamping. After confirming renal function preservation, right PN was performed with a 28-minute long renovascular clamping. Due to long lasting postoperative urinary leakage of the right kidney, the transuretheral stent placed during the surgery was replaced by a percutaneous transvesical urinary stent 8 weeks postoperatively. The patient's burden was reduced by avoiding discomfort and catheter troubles. The urinary leakage was cured 12 weeks postoperatively. Pathological examinations revealed both tumors were clear cell renal cell carcinoma, pT1b with negative surgical margin. The estimated glomerular filtration rates 3 years after PN was well preserved at 59.8 ml/min/1.73m². The patient has been doing well without cancer recurrence for 3 years. The three-dimensional kidney models facilitated us to understand the renal vascular anatomy as well as spatial relationships between the tumor and the urinary collecting system. We could rehearse the surgical procedure and take measures against conceivable complications. Preoperative simulations using 3D kidney models and percutaneous transvesical urinary stenting may help to complete partial nephrectomy in patients with highly complexed renal tumors.