Performing an early systematic Doppler-ultrasound fails to prevent hemorrhagic complications after complex partial nephrectomy
Background: The aim of this work was to assess the clinical relevance of a systematic postoperative Doppler-ultrasound (DU) after complex partial nephrectomy (PN). Materials and methods: All patients who underwent open, laparoscopic or robotic PN from 2014 to 2017 at our institution were included. P...
| Main Authors: | , , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
SAGE Publishing
2019-02-01
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| Series: | Therapeutic Advances in Urology |
| Online Access: | https://doi.org/10.1177/1756287219828966 |
| _version_ | 1828955657843245056 |
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| author | Inès Dominique Charles Dariane Cyril Fourniol Thomas Le Guilchet Sophie Hurel Eric Fontaine Eric Mandron Francois Audenet Arnaud Mejean Marc Olivier Timsit |
| author_facet | Inès Dominique Charles Dariane Cyril Fourniol Thomas Le Guilchet Sophie Hurel Eric Fontaine Eric Mandron Francois Audenet Arnaud Mejean Marc Olivier Timsit |
| author_sort | Inès Dominique |
| collection | DOAJ |
| description | Background: The aim of this work was to assess the clinical relevance of a systematic postoperative Doppler-ultrasound (DU) after complex partial nephrectomy (PN). Materials and methods: All patients who underwent open, laparoscopic or robotic PN from 2014 to 2017 at our institution were included. Postoperative hemorrhagic complications (HCs) were defined as the occurrence of blood transfusion, hemorrhagic shock, arterial embolization, or re-hospitalization for hematoma. DU was systematically performed between post-op day 4 and 7 for every complex tumor (RENAL score ⩾ 7). DU was considered positive in the presence of pseudoaneurysm (PA) or arteriovenous fistula (AVF). Results: Among 194 patients, 117 underwent DU (60.3%). We reported 22 HCs (11.3%) requiring 8 selective embolization procedures (4.1%). HCs occurred during the hospital stay in 17 patients (77.3%), thus directly diagnosed on a computed tomography scan. Among the five patients (22.7%) with HC occurring after hospital discharge, between day 7 to 15, four had a previously negative systematic DU. Overall, systematic DU was positive in only five patients (4.3%) with only one patient of 194 (0.5%) undergoing preventive embolization of a PA-AVF. The negative predictive values (NPVs) and positive predictive values of DU were respectively 96.5% and 5%, with 20% sensitivity and 96.5% specificity. Conclusions: Our results may suggest offering systematic DU in patients under antiplatelet therapies, with high tumor size (>T1b), or early postoperative hemoglobin variations. A high NPV of DU might be counterbalanced by its low sensibility. Since all secondary HCs occurred between postoperative day 7 to 15, our results may suggest differing DU in selected cases. |
| first_indexed | 2024-12-14T07:55:24Z |
| format | Article |
| id | doaj.art-53d979834fe046dcb2947626abc31098 |
| institution | Directory Open Access Journal |
| issn | 1756-2880 |
| language | English |
| last_indexed | 2024-12-14T07:55:24Z |
| publishDate | 2019-02-01 |
| publisher | SAGE Publishing |
| record_format | Article |
| series | Therapeutic Advances in Urology |
| spelling | doaj.art-53d979834fe046dcb2947626abc310982022-12-21T23:10:33ZengSAGE PublishingTherapeutic Advances in Urology1756-28802019-02-011110.1177/1756287219828966Performing an early systematic Doppler-ultrasound fails to prevent hemorrhagic complications after complex partial nephrectomyInès DominiqueCharles DarianeCyril FourniolThomas Le GuilchetSophie HurelEric FontaineEric MandronFrancois AudenetArnaud MejeanMarc Olivier TimsitBackground: The aim of this work was to assess the clinical relevance of a systematic postoperative Doppler-ultrasound (DU) after complex partial nephrectomy (PN). Materials and methods: All patients who underwent open, laparoscopic or robotic PN from 2014 to 2017 at our institution were included. Postoperative hemorrhagic complications (HCs) were defined as the occurrence of blood transfusion, hemorrhagic shock, arterial embolization, or re-hospitalization for hematoma. DU was systematically performed between post-op day 4 and 7 for every complex tumor (RENAL score ⩾ 7). DU was considered positive in the presence of pseudoaneurysm (PA) or arteriovenous fistula (AVF). Results: Among 194 patients, 117 underwent DU (60.3%). We reported 22 HCs (11.3%) requiring 8 selective embolization procedures (4.1%). HCs occurred during the hospital stay in 17 patients (77.3%), thus directly diagnosed on a computed tomography scan. Among the five patients (22.7%) with HC occurring after hospital discharge, between day 7 to 15, four had a previously negative systematic DU. Overall, systematic DU was positive in only five patients (4.3%) with only one patient of 194 (0.5%) undergoing preventive embolization of a PA-AVF. The negative predictive values (NPVs) and positive predictive values of DU were respectively 96.5% and 5%, with 20% sensitivity and 96.5% specificity. Conclusions: Our results may suggest offering systematic DU in patients under antiplatelet therapies, with high tumor size (>T1b), or early postoperative hemoglobin variations. A high NPV of DU might be counterbalanced by its low sensibility. Since all secondary HCs occurred between postoperative day 7 to 15, our results may suggest differing DU in selected cases.https://doi.org/10.1177/1756287219828966 |
| spellingShingle | Inès Dominique Charles Dariane Cyril Fourniol Thomas Le Guilchet Sophie Hurel Eric Fontaine Eric Mandron Francois Audenet Arnaud Mejean Marc Olivier Timsit Performing an early systematic Doppler-ultrasound fails to prevent hemorrhagic complications after complex partial nephrectomy Therapeutic Advances in Urology |
| title | Performing an early systematic Doppler-ultrasound fails to prevent hemorrhagic complications after complex partial nephrectomy |
| title_full | Performing an early systematic Doppler-ultrasound fails to prevent hemorrhagic complications after complex partial nephrectomy |
| title_fullStr | Performing an early systematic Doppler-ultrasound fails to prevent hemorrhagic complications after complex partial nephrectomy |
| title_full_unstemmed | Performing an early systematic Doppler-ultrasound fails to prevent hemorrhagic complications after complex partial nephrectomy |
| title_short | Performing an early systematic Doppler-ultrasound fails to prevent hemorrhagic complications after complex partial nephrectomy |
| title_sort | performing an early systematic doppler ultrasound fails to prevent hemorrhagic complications after complex partial nephrectomy |
| url | https://doi.org/10.1177/1756287219828966 |
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