OUK REAKSMEY #289, st 156, Sangkat Teuk Laak II, Khan Tuol Kok, - - PDF document

OUK REAKSMEY

#289, st 156, Sangkat Teuk Laak II, Khan Tuol Kok, Phnom Penh, Cambodia (+855)17706092 reaksmeyouk016@gmail.com EDUCATION DFMS en Urologie (Diplôme de formation médicale spécialisée en Urologie), Claude Bernard Lyon I University, Lyon, France, 2018-2019. DES en Uro-Chirurgie ( Diplôme d’étude spécialisée), University of Health Sciences, 2015-2019 MD, University of Health Sciences, Phnom Penh, Cambodia 2009-2015 B.Ed (Bachelor of Education), Institute of Foreign Language, 2010-2014 TRAINING Residency in Urology and Renal transplantation, Edouard Herriot Hospital, Lyon, France 2018-2019. Residency in Urology, Kossamak Hospital, Phnom Penh Cambodia, 2017-2018. Residency in General and Pediatric surgery, Phnom Penh, Cambodia 2015-2017. PUBLICATIONS Reaksmey OUK et al. (2014). The role of partial nephrectomy in the management of renal angiomyolipoma, Phnom Penh, Cambodia. Reaksmey OUK et al. (2015). The management of genito-urinary melioidosis in Hospital Center of Hope, Phnom Penh, Cambodia. Reaksmey OUK et al. (2016). Retrospective study on the management of muscle invasive bladder cancer among 10 cases in Hospital Center of Hope, Phnom Penh, Cambodia. Reaksmey OUK et al. (2017). The management of retrocaval ureter, one case experience from Hospital Center of Hope, Phnom Penh, Cambodia.

SELECTED 2016 – “How to prevent stone recurrence” AURC (Asian urology resident course), Hongkong. PRESENTATION 2017- “The role of retroperitoneal lymph node dissection for renal cancer” AURC, Japan. PARTICIPATION 2016 ARUC and UAA (Urological Association of Asia), Singapore. 2017 ARUC and UAA (Urological Association of Asia), Hongkong. 2018 ARUC and UAA (Urological Association of Asia), Japan 2018 USANZ (Urological Society of Australia and New Zealand), Melbourne, Australia. PROFESSIONAL Member of Urological Association of Asia AFFILIATION Member of American Urological Association Member of Cambodia Urological Association LANGUAGE Khmer: Native proficiency English: Proficiency French: Good (B2) PERSONAL Road cycling, Tennis, Football, Running, Hiking INTEREST Motorcycle, Mountain Biking

Retrospective Study on the Role of Renal Autotransplantation for the Management of Complex Renal Carcinoma and Loin Pain Hematuria Syndrome in the period of 1 year, 2 cases of experience from Edouart Herriot Hospital, Lyon, French Reaksmey OUK1, 2,*, Ricardo Codas11, Sébastien Crouzet1, Xavier Matin1, Lionel Badet1

1Edouart Herriot Hospital, Lyon, French 2Department of Urology, Cambodia-China Friendship Preah Kossamak Hospital *Corresponding Author: reaksmeyouk016@gmail.com

ABSTRACT

Objective: To review the role of renal auto-transplantation for the management of complex RCC and loin pain hematuria syndrome in our hospital university, Lyon, French. Material and methods: It is a retrospective study, during 1 year in 2018-2019. We had done around 18 renal auto-transplantations but we excluded robotic auto-renal transplantation. We only included the only 2 cases by which were done by laparscopic surgery in our service. Results: Case 1: A 57 year old man present to us a 9 cm mass in the right kidney. His antecedents are splenectomy and left nephrectomy after accident in 1978. His pass medical history is marked by the fact that in the last 2 year he has been observed strictly for left renal mass, which is getting bigger and bigger. His last CT scan showed left renal mass on the posterior aspect of the kidney which make it difficile to do partial nephrectomy and it would increase the ischemia time. So, with the idea of different specialists, we decided to do renal autotransplantation. After the operation, there is no complication noted beside pain which is treated by morphine. Doppler ultrasound in the 1st and CT scan in 7th day showed no thrombosis of the renal vein and a functionning kidney. Case 2: A 48 year old female present to us with a suspection of loin pain hematuria

• syndrome. Her antecedents are thyroid cancer treated with total thyroidectomy, Deep vein thrombosis and left

colicky pain in 2/3 of the year. We had done an exhaustive of medical procedure and imaging to rule out

• ther causes of pain and we finally arrived to conclude that she has LPHS. We had done RAT and there is no

complication seen after operation. In 1 and 3 months, we could see that she has no pain and she better integrated into her social life. Conclusion: Renal auto-transplantation is a complex procedure which requires an experience transplant

• surgeon. Its indications go beyond complex ureteral injuries. Today, it is usually indicated in the management
• f LPHS, Complex RCC, and renal artery anevrism. And, it is usually considered a last resort type of

procedure. Keywords: Complex RCC (Renal cell carcinoma) ; LPHS (Loin pain hematuria syndrome) ; RAT (Renal auto-transplantation

Retrospective study on the role of renal autotransplantation for the management of complex renal carcinoma and loin pain hematuria syndrome in the period of 1 year, 2 cases of experience from Edouard Herriot Hospital, Lyon, France Reaksmey OUK1, 2,*, Hakim Fashi Ferhi1, Ricardo Codas11, Sébastien Crouzet1, Xavier Matin1, Lionel Badet1

1Edouart Herriot Hospital, Lyon, French 2Department of Urology, Cambodia-China Friendship Preah Kossamak Hospital *Corresponding Author: reaksmeyouk016@gmail.com

Introduction Renal auto-transplantation (RAT) is a suitable option for managing patients with major ureteric injury. The first case was performed by JD Hardy in 1963 to repair a ureteric injury [1]. Conventional RAT is, however, underutilized because of its invasiveness. The laparoscopic approach has now become commonplace in many urological diseases’ management, decreasing the morbidity of RAT [2]. The current gold standard approach is a laparoscopic nephrectomy followed by open auto-transplantation [3]. Robot-assisted RAT (R-RAT) is a recent innovative application and there is a trend that tend to do a complete intracoporal renal autotransplantation. Presentation of the case Case 1: A 57-year-old man present to us a 9 cm mass in the right kidney. His antecedents are splenectomy and left nephrectomy after accident in 1978. His pass medical history is marked by the fact that in the last 2 years he has been observed strictly for left renal mass, which is getting bigger and bigger. His last CT scan showed left renal mass on the posterior aspect of the kidney which make it difficile to do partial nephrectomy and it would increase the ischemia time. So, with the idea of different specialists, we decided to do renal autotransplantation.

Figure 1 Complex renal tumor of the renal hilum

After the operation, there is no complication noted beside pain which is treated by morphine. Doppler ultrasound in the 1st and CT scan in 7th day showed no thrombosis of the renal vein and a functioning kidney.

Figure 2 CT in 7th day post-operation

Case 2: A 48-year-old female present to us with a suspicion of loin pain hematuria syndrome. Her antecedents are thyroid cancer treated with total thyroidectomy, Deep vein thrombosis and left colicky pain in 2/3 of the year.

Figure 3 CT on patient with LPHS

We had done an exhaustive of medical procedure and imaging to rule out other causes of pain and we finally arrived to conclude that she has LPHS.

Figure 4 Lateral-to-end renal artery and external iliac artery anastomosis

We had done RAT and there is no complication seen after operation. In 1 and 3 months, we could see that she has no pain and she better integrated into her social life.

Figure 5 Complete anastomosis

Material and Methods – 2 Patients – Age 57 et 48 years old – Periode : 1st January 2018 à 30th July 2019 – Exclusion : – Robotic autotransplantation – The same operation in Lyon Sud Hospital

– Pathology : Complex renal tumor and LPHS – Procedure : Laparoscopic nephrectomy + Iliac incision – Post-op complication : Pain EVA 6 (Morphine) – Post-op evaluation : Doppler D1 good, CT D7 good – Limit of study : No long term result Discussion The first study for the role of renal autotransplantation at Edouad Herriot Hospital was conducted in 2012 on the managment of 4 cases of LPHS. It is precisely focus on the role of mini invasive procedure comparing to traditional surgery. And they come up with a conclusion that mini-invasive procedure is prefered since they

• ffer the following advantages : Less pain, fast recovery and short hospital stay [4]. Besides, there is the

study at CHU de Lille on the managment of complex intra-renal artery aneurism. They perform a very successful surgery by 2 teams which consist of urologist and vascular surgeon. – Objectives : – Management of complexe renal artery aneuvrism (Vascular and uro team) + Exclusion (Possibility of endovascular treatment) + Traitement (Complex morphology of the aneuvrism + risk of spontaneous repture) – Methods : – Between 2015-16, 4 cases. Kidney harvesting (2 Lombo + 2 Lap) . Saphenous vein

• harvesting. Kidney preparation ( Dissection of the anevrism + resection et reimplantation of

the saphenous vein) + Transplantation – Results : – Mean operative time 420 min + No post- (Saphenous V thrombosis => Medical treatment) . CT D7 perfect . IRM 3 months perfect – Conclusion : – Last options of treatment – Experienced surgeon – 2 teams

So, besides the use of renal autotransplantation on LPHS and renal artery aneurism, there is a study on its indication by which we could classify [5] : – Renovascular disease – The indications for surgery have included renal artery aneurysms, fibromuscular dysplasia, Takayasu disease, and atherosclerosis. – Ureteral diseases – Conventional techniques include ureteroureterostomy, psoas hitch procedure, Boari flap, transureteroureterostomy, or transureteropyelostomy reconstruction. These techniques cannot be used in severe ureteral loss or high ureteral injury. Bowel interposition can be an alternative technique but is associated with complications. – Neoplastic disease – There is controversy about surgical treatment of bilateral renal tumors or tumors in solitary kidneys. – Radical nephrectomy may necessitate chronic dialysis and allotransplant with chronic immunosuppression in patients who have neoplastic disease. Attempts at renal preservation by in situ excision or extracorporeal repair and autotransplant are viable alternatives but there is concern about ensuring complete tumor excision. In 2014, Gordon et al. published the first case of completely intra-corporeal R-RAT in a 56-year-old male with a major left ureteral loss after endoscopic treatment of an obstructive stone. The warm ischemia time

• cold lactated Ringer solution

under gravity. This solution was chosen because of its lack of peritoneal toxicity. The RAKT was performed according to the technique of Oberholze et al. [7]. No postoperative complications were observed and kidney function was assessed by Doppler ultrasound and intravenous urogram. A year later, Lee et al. performed the second case of total intracorporeal R-RAT in a 38-year-old female with

n and re- was comparable to preoperatively. Conclusion Renal autotransplantation is an effective treatment for complex ureteric lesions and renal vascular abnormalities, LPHS and Clear cell carcinoma on a solitary kidney with good long-term results. Surgical complications are common, but usually minor. As a difficult surgery, it should be performed by experienced surgeons in kidney transplantation. Complex and proximal ureteral lesions are currently the main indication

• f this procedure.

References 1. Hardy J.D., Eraslan S. Autotransplantation of the kidney for high ureteral injury. J.

• Urol. 1963;90:563–574.

2. Tran G., Ramaswamy K., Chi T. Laparoscopic nephrectomy with autotransplantation: safety, efficacy and long-term durability. J. Urol. 2015;194:738–743. 3. Azhar B., Patel S., Chadha P. Indications for renal autotransplant: an overview. Exp. Clin.

• Transplant. 2015;13:109–114.

4.

• H. Almainman et al. (2012). A mini-invasive approach to reanl autotransplantation in the

management of loin pain hematuria syndrome. Service d’urologie et chirurgie de la transplantation, hôpital Edouad-Herroit, Lyon, France. 5.

• S. Bouyé et al. (2015) Auto-transplantation rénale pour cure ex-vivo d’anécrisme complexe de

l’artère rénale, CHU de Lille, Lile, France. 6. Experimental and Clinical Transplantation (2015) 2: 109-114 7. Gordon Z.N., Angell J., Abaza R. Completely intracorporeal robotic renal autotransplantation. J.

• Urol. 2014;192:1516–1522.

8.

Oberholzer J., Giulianotti P., Danielson K.K. Minimally invasive robotic kidney transplantation for

• bese patients previously denied access to transplantation. Am. J. Transplant. 2013;13:721–
• 7289. Lee J.Y., Alzahrani T., Ordon M. Intra-corporeal robotic renal auto-transplantation. Can. Urol.
• Assoc. J. 2015;9:E748–749