Abstract
Objective
To study the impact of periarterial papaverine application on the postoperative glomerular filtration rate (GFR) after retroperitoneoscopic partial nephrectomy (PN).
Materials and methods
A consecutive series of patients underwent retroperitoneoscopic PN with intraoperative, periarterial application of 50 mg of papaverine. These patients were compared with a group of patients who underwent retroperitoneoscopic PN at this institution prior to this protocol. Patients were matched for preoperative GFR, tumor size, ischemia time, and operative time.
Results
In total, 37 patients who received periarterial papaverine (P) and 37 patients without periarterial papaverine, who served as controls (C), were included in this analysis and matched according to preoperative GFR (P: 98.2, C: 97.8 ml/min/1.72 m2), tumor size (P: 2.5 cm, C: 2.5 cm), ischemia time (P: 22 min, C: 23 min), and operative time (P: 86 min, C: 85 min). Postoperative GFR was 86.4 ml/min/1.72 m2 in controls (C) and 91.8 ml/min/1.72 m2 in the papaverine group. The pre- to postoperative decrease in GFR was reduced by 56.9% in the papaverine group compared with controls (relative decrease in GFR: P: 5.3% vs. C: 12.5%; P = 0.02). Intra- and postoperative complications were pneumothorax (P: n = 2, C: n = 3), urinary fistula (P: n = 0, C: n = 2), and one suture-fixed drainage (P: n = 1, C: n = 0). No papaverine-related side effects were observed, and the surgical procedure was not hampered by the periarterial application of papaverine.
Conclusion
As with laparoscopic donor nephrectomy, periarterial papaverine seems to improve postoperative renal function after retroperitoneoscopic partial nephrectomy. This nephroprotective effect might be particularly advantageous for patients with an impaired renal function preoperatively.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Virag R (1982) Intracavernous injection of papaverine for erectile failure. Letter to the editor. Lancet 2:938
Hopps CV, Lemer ML, Schlegel PN et al (2003) Intraoperative varicocele anatomy: a microscopic study of the inguinal versus subinguinal approach. J Urol 170:2366–2370
Zacherl J, Stangl M, Feussner H et al (2002) Periarterial papaverine application improves intraoperative kidney function during laparoscopic donor nephrectomy. J Surg Res 103:268–271
Zacherl J, Thein E, Stangl M et al (2003) The influence of periarterial papaverine application on intraoperative renal function and blood flow during laparoscopic donor nephrectomy in a pig model. Surg Endosc 17:1231–1236
Zacherl J, Bock S, Feussner H et al (2004) Periarterial application of papaverine during laparoscopic donor nephrectomy improves early graft function after kidney transplantation in pigs. Surg Endosc 18:417–420
Kavoussi LR (2000) Laparoscopic donor nephrectomy. Kidney Int 57:2175–2186
Nogueira JM, Cangro CB, Fink JC et al (1999) A comparison of recipient renal outcomes with laparoscopic versus open live donor nephrectomy. Transplantation 67:722–728
Marszalek M, Meixl H, Polajnar M et al (2009) Laparoscopic and open partial nephrectomy: a matched-pair comparison of 200 patients. Eur Urol 55:1171–1178
Lippi G, Montagnana M, Banfi G et al (2008) Comparison of 2 methods for the calculation of estimated glomerular filtration rate. Lab Med 39:35–37
Lane BR, Novick AC, Babineau D et al (2008) Comparison of laparoscopic and open partial nephrectomy for tumor in a solitary kidney. J Urol 179:847–851
Becker F, Van Poppel H, Hakenberg OW et al (2009) Assessing the impact of ischaemia time during partial nephrectomy. Eur Urol 56:625–635
Gearhart JP, Jeffs RD (1985) The use of topical vasodilatators as an adjunct in infant renal surgery. J Urol 134:298–300
Hausmann H, Photiadis J, Hatzer R (1996) Blood flow in the internal mammary artery after the administration of papaverine during coronary artery bypass grafting. Tex Heart Inst J 23:279–283
Foxworthy JV, Monro JL, Lewis B (1985) The response to papaverine in coronary artery bypass graft flows. J Cardiovasc Surg 26:439–442
Hillier C, Watt PA, Spyt TJ et al (1992) Contraction and relaxation of human internal mammary artery after intraluminal administration of papaverine. Ann Thorac Surg 53:1033–1037
Ali AT, Montgomery WD, Santamore WP et al (1997) Preventing gastroepiploic artery spasm: papaverine vs calcium channel blockade. J Surg Res 71:41–48
Bahcivan M, Kolbakir F, Karamustafa H et al (2007) Endothoracic papaverine application for internal thoracic artery harvest. Asian Cardiovasc Thorac Ann 15:234–237
Junghans T, Böhm B, Gründel K et al (1997) Does pneumoperitoneum with different gases, body positions, and intraperitoneal pressures influence renal and hepatic blood flow? Surgery 121:206–241
Acknowledgments
None.
Conflict of interest
No conflict of interests exist.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Marszalek, M., Meixl, H., Pitzler, C. et al. Periarterial papaverine improves early postoperative renal function after retroperitoneoscopic partial nephrectomy. World J Urol 31, 829–833 (2013). https://doi.org/10.1007/s00345-011-0712-1
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00345-011-0712-1