Periarterial papaverine improves early postoperative renal function after retroperitoneoscopic partial nephrectomy.

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 m(2)), 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 m(2) in controls (C) and 91.8 ml/min/1.72 m(2) 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.