The curative management of renal cell carcinoma (RCC) remains surgical. Recent advances in preoperative staging, specifically modern imaging techniques, and improvements in surgical techniques have made nephron-sparing surgery (NSS) an attractive alternative to radical nephrectomy in select patients.
History of the Procedure: Over the past decade, an increasing body of literature regarding not only the indications but also the safety and efficacy of NSS for RCC has developed.
Clinical: The clinical utility of NSS is revealed when several factors are considered. First, RCC usually does not become symptomatic until late in its course. Lesions detected incidentally tend to be smaller and of lesser grade and thus more amenable to conservative surgery.
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Both adult and pediatric urologists frequently encounter patients with ureteropelvic junction (UPJ) obstruction. Congenital abnormalities may be observed in both groups, but adults also may present with obstruction following previous surgery or other disorders that can cause inflammation of the upper urinary tract.
The critical decision to be made is whether or not the radiologic findings correlate with the physiologic picture. In other words, those patients with severely dilated hydronephrotic kidneys may, in fact, drain well when studied appropriately. Defining the exact anatomy and function of these kidneys is crucial when evaluating and treating these patients..... Full article at E-MEDICINE
