PD66-06 RANDOMIZED, CONTROLLED, DOUBLE BLINDED, PROSPECTIVE EVALUATION OF RENAL FUNCTION FOLLOWING MANNITOL ADMINISTRATION DURING MINIMALLY INVASIVE ROBOTIC-ASSISTED LAPAROSCOPIC PARTIAL NEPHRECTOMY

Abstract

You have accessJournal of UrologyKidney Cancer: Localized: Surgical Therapy VI1 Apr 2017PD66-06 RANDOMIZED, CONTROLLED, DOUBLE BLINDED, PROSPECTIVE EVALUATION OF RENAL FUNCTION FOLLOWING MANNITOL ADMINISTRATION DURING MINIMALLY INVASIVE ROBOTIC-ASSISTED LAPAROSCOPIC PARTIAL NEPHRECTOMY Stephen Phillips, Kellen Choi, Sharon Hill, and Deem Samuel Stephen PhillipsStephen Phillips More articles by this author , Kellen ChoiKellen Choi More articles by this author , Sharon HillSharon Hill More articles by this author , and Deem SamuelDeem Samuel More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.2969AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Mannitol solution has been an agent utilized to improve kidney circulation and decrease reperfusion injury to attempt to maintain renal function. With the development of partial nephrectomy (PN) as the preferred surgical approach, the use of mannitol was adopted as a way to theoretically prevent damage during the kidney's ischemic time. After oncologic outcomes, maintenance of renal function is a principal goal. With advancements in minimally invasive techniques, the utilization of mannitol has been called into question. Robotic-assisted laparoscopic partial nephrectomy (RALPN) has been shown to decrease warm ischemia time, which may potentially minimize the benefit of mannitol. To date, no prospective, randomized, controlled trials have investigated the use of mannitol in the robotic procedure. We hypothesize that the intra-operative mannitol use during RALPN provides no statistically significant benefit for post-operative renal function outcomes. METHODS We conducted a randomized, controlled, double blinded, single surgeon, prospective study to assess renal function after RALPN. Patients were randomized into a control group with intravenous normal saline infusion prior to clamping of the vessels or to an experimental group with an infusion of mannitol. Monitoring of Creatinine (sCr) and estimated glomerular filtration rate (eGFR) were obtained prior to the surgery as well as post operatively at 24 hours, 1 week, and 30 days. A descriptive analysis of the study groups was performed using means, standard deviations, ranges and percentages. Subgroup comparisons examined differences in the percent change of eGFR and sCR post-surgery. Continuous variables were analyzed using the Student's t-test and categorical variables using Fisher's Exact Test with a p < 0.05 considered statistically significant. RESULTS Patient demographics as well as tumor characteristics were similar between the two groups other than patient BMI. Preoperative sCR and eGFR showed no statistical differences between the groups and evaluation of percent change in sCR and eGFR after surgery did not indicate a significant difference between the groups after RALPN (p>0.05). CONCLUSIONS After prospective analysis of the change in post-operative renal function of randomized groups following RALPN, we determined no statistically significance. Further evaluation with increased numbers, long term follow-up, and expansion to multiple institutions may further support this conclusion. Based on this evaluation, infusion of mannitol does not provide significant improvement of maintenance of renal functions after RALPN. © 2017FiguresReferencesRelatedDetailsCited byLaguna M (2018) Re: Intravenous Mannitol versus Placebo during Partial Nephrectomy in Patients with Normal Kidney Function: A Double-Blind, Clinically-Integrated, Randomized TrialJournal of Urology, VOL. 199, NO. 5, (1108-1109), Online publication date: 1-May-2018. Volume 197Issue 4SApril 2017Page: e1273 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Stephen Phillips More articles by this author Kellen Choi More articles by this author Sharon Hill More articles by this author Deem Samuel More articles by this author E