PTU - Polskie Towarzystwo Urologiczne
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Bilateral partial nephrectomy due to the tumors
Article published in Urologia Polska 2008/61/Supl. 1.


Przemysław Dudek, Lech Lipiec, Jacek Adamczyk, Michał Lipowski
Oddział Urologii Szpital Specjalistyczny im. św. Łukasza w Końskich



Nephron-sparing surgery (NSS) may be efficient in case of tumours >4 cm. In guidelines the gold standard is radical nephrectomy. Nephron-sparing surgery is applied in case of solitary kidney and bilateral tumours.‑


We present case report with bilateral large kidney tumors.

Materials and methods.

75 years old woman hospitalized due to fatigue and weight loss. We confirmed the presence of large tumors in both kidneys after USG and CT. In left kidney tumor had 7.5 x 6 x 5.5 cm. (it was located in superior pole near large vas of the kidney). Tumor in right side had 6 x 5.5 x 5 cm. in superior pole. Furthermore we found 1 cm. tumour in the right adrenal. After nephrological and endocrinological consultation and angiography of the artery of the kidney we performed bilateral partial nephrectomy and adrenalectomy on the right. First we resected tumor of the left kidney – time of cold ischemia 32 min. Through disadvantageous localization of the tumor we had to resect part of renal vein. Second operation was performed one month later. We performed partial nephrectomy and right adrenalectomy (time of cold ischemia – 22 min).


Operation and hospitalisation was complicated by mild renal insufficiency. After first operation we observed transient elevation of the concentration of urea (max. to 65 mg/dl, and creatynine to 1.8 ng/ml). Histological examination of the tumor: ca. clarocellularae NG 4. After second operation max. concentration of urea was 104.1 mg/dl and creatinine 3.24 mg/dl. Concentration decreased to: urea 65 mg/dl and creatinine 2.98 ng/ml. Histological examination – ca.clarocellularae NG2. in the part of kidney and adenoma of the adrenal gland. We did not observe local recurrence and distant metastases (x-ray chest, abdominal CT, LDH) during one year of observation. Latest concentration of creatinine 2.0 mg/dl.


NSS is safe method with good oncological and functional result in case of bilateral (large) tumors of the kidney >4 cm. We always should consider NSS in case of bilateral tumors even though diameter of the tumors is greater then 4 cm. Precise diagnostics (with angiography) and close cooperation with nephrologist are necessary.