308:
176:
29:
261:. Removing organs through orifices prevents some of the pain of an incision and the need for a cosmetically unappealing larger scar. Any advance which leads to a decrease in pain and scarring has the potential to boost donor numbers. This operation has also taken place at the Cleveland Clinic, which first performed transvaginal Nephrectomy. Living donation has a mortality risk of 0.03% during the procedure and seems to result in similar health outcomes to controls.
439:. Partial nephrectomy has been shown to maintain kidney function better than total removal. There is some debate whether this preservation of kidney function leads to long-term benefits to the patient. Some studies have found that patients treated by partial nephrectomy live longer than patients who had their whole kidney removed. Other studies have found the opposite. Partial nephrectomy has been associated with better
394:
generally treated with radical nephrectomy unless the tumor occurs in a solitary kidney, there are tumors on both sides or kidney function is bad. Patients who are told their tumors are too big or too hard for a partial nephrectomy may want to seek another opinion because surgeons who take care of many patients with kidney cancer are more often able to spare the kidney than those who only see a few cases.
415:
kidneys and 25% of it will go into the kidneys with each heart beat. In order to safely remove the kidney tumor, the blood flow to the kidney is often temporarily blocked off. The tumor is then cut out and the surgeon must sew the remaining kidney back together. Partial nephrectomy is often an alternative to complete, or radical, nephrectomy for
1248:
Weight, Christopher J.; Crispen, Paul L.; Breau, Rodney H.; Kim, Simon P.; Lohse, Christine M.; Boorjian, Stephen A.; Thompson, R. Houston; Leibovich, Bradley C. (2013). "Practice-setting and surgeon characteristics heavily influence the decision to perform partial nephrectomy among
American Urologic
1377:
Kim, Simon P.; Murad, M. Hassan; Thompson, R. Houston; Boorjian, Stephen A.; Weight, Christopher J.; Han, Leona C.; Erwin, Patricia J.; Costello, Brian A.; Chow, George K.; Leibovich, Bradley C. (2012). "Comparative
Effectiveness for Survival and Renal Function of Partial and Radical Nephrectomy for
289:
suggests that persons with only one kidney including those who have donated a kidney for transplantation or those whose kidney was removed for cancer, should avoid high protein diet and limit their protein intake to less than one gram per kilogram body weight per day in order to reduce the long-term
1169:
Campbell, Steven C.; Novick, Andrew C.; Belldegrun, Arie; Blute, Michael L.; Chow, George K.; Derweesh, Ithaar H.; Faraday, Martha M.; Kaouk, Jihad H.; Leveillee, Raymond J.; Matin, Surena F.; Russo, Paul; Uzzo, Robert G.; Practice
Guidelines Committee of the American Urological Association (2009).
203:
and blood vessels are disconnected, and the kidney is then removed. The laparoscopic approach utilizes three or four small (5–10 mm) cuts in the abdominal and flank area. The kidney is completely detached inside the body and then placed in a bag. One of the incisions is then expanded to remove
1212:
Weight, Christopher J.; Larson, Benjamin T.; Fergany, Amr F.; Gao, Tianming; Lane, Brian R.; Campbell, Steven C.; Kaouk, Jihad H.; Klein, Eric A.; Novick, Andrew C. (2010). "Nephrectomy
Induced Chronic Renal Insufficiency is Associated with Increased Risk of Cardiovascular Death and Death from Any
380:
Czerny first described a partial nephrectomy in 1890. However, due to limited x-ray and imaging capabilities to find small kidney tumors and significant complications associated with early operations it was largely abandoned. More recently, with improved imaging, improved surgical techniques and
280:
balance and fluids are carefully monitored, because these are the functions of the kidneys. It is possible that the remaining kidney does not take over all functionality. A patient has to stay in the hospital between 2 and 7 days depending on the procedure and complications. Patients who have had
414:
approach. The patient is typically placed on the operating room bed lying on the side opposite the kidney tumor. The goal of the procedure is to remove the kidney tumor along with a thin rim of normal kidney tissue. Because the kidneys clean the blood, all blood eventually flows through the
393:
Partial nephrectomy is also the standard of care for nearly all patients with small renal masses (<4 cm in size). Most renal masses between 4-7 centimeters can also be treated by partial nephrectomy if they are located in the proper position. Renal masses larger than 7 centimeters are
1445:
Van Poppel, Hendrik; Da Pozzo, Luigi; Albrecht, Walter; Matveev, Vsevolod; Bono, Aldo; Borkowski, Andrzej; Colombel, Marc; Klotz, Laurence; Skinner, Eila; Keane, Thomas; Marreaud, Sandrine; Collette, Sandra; Sylvester, Richard (2011). "A Prospective, Randomised EORTC Intergroup Phase 3 Study
1297:
Gill, Inderbir S.; Kavoussi, Louis R.; Lane, Brian R.; Blute, Michael L.; Babineau, Denise; Colombo Jr, J. Roberto; Frank, Igor; Permpongkosol, Sompol; Weight, Christopher J.; Kaouk, Jihad H.; Kattan, Michael W.; Novick, Andrew C. (2007). "Comparison of 1,800 Laparoscopic and Open
Partial
1333:
Kim, Simon P.; Leibovich, Bradley C.; Shah, Nilay D.; Weight, Christopher J.; Borah, Bijan J.; Han, Leona C.; Boorjian, Stephen A.; Thompson, R. Houston (2013). "The relationship of postoperative complications with in-hospital outcomes and costs after renal surgery for kidney cancer".
1481:
Clark, Peter E; Schover, Leslie R; Uzzo, Robert G; Hafez, Khaled S; Rybicki, Lisa A; Novick, Andrew C (2001). "Quality of life and psychological adaptation after surgical treatment for localized renal cell carcinoma: Impact of the amount of remaining renal tissue".
389:
A partial nephrectomy should be attempted when there is a kidney tumor in a solitary kidney, when there are kidney tumors in both kidneys, or when removing the entire kidney could result in kidney failure and the need for dialysis.
1409:
Weight, Christopher J.; Miller, David C.; Campbell, Steven C.; Derweesh, Ithaar H.; Lane, Brian R.; Messing, Edward M. (2013). "The
Management of a Clinical T1b Renal Tumor in the Presence of a Normal Contralateral Kidney".
281:
open surgery will have to stay in hospital longer than those who have had laparoscopic surgery. In long-term, a person with only one kidney ("solitary kidney") may be more prone to developing
121:. The patient had had a large tumor and the operation was initially successful, but the patient died fifteen days later. The first planned nephrectomy was performed by the German surgeon
822:
Crotty, KL; MacAluso Jr, JN (2000). "Partial colectomy required for resection of renal cell carcinoma: A case report and review of treatment options for locally advanced disease".
787:
Hom, David; Eiley, David; Lumerman, Jeffrey H.; Siegel, David N.; Goldfischer, Evan R.; Smith, Arthur D. (1999). "Complete Renal
Embolization As an Alternative to Nephrectomy".
773:
427:
Patients who undergo partial nephrectomy experience complications around 15-25% of the time. The most common complications are bleeding, infection, and urinary leak.
285:(CKD). A 2014 study suggested that lifelong risk of CKD is several-fold higher in kidney donors, although the absolute risk is still very small. A 2017 article in the
241:, the pancreas or the liver. If the cancer has not spread to distant sites, it may be safely and completely removed surgically via open or laparoscopic techniques.
208:
and removed through the small incisions. Recently, this procedure is performed through a single incision in the patient's navel. This advanced technique is called
1530:
215:
A total nephrectomy is the removal of at least the entire kidney, whereas a 'radical nephrectomy' also includes at least some perinephric fat, possibly including
1557:
152:
Nephrectomy for renal cell carcinoma is rapidly being modified to allow partial removal of the kidney. Nephrectomy is also performed for the purpose of living
149:) and a congenitally small kidney (in which the kidney is swelling, causing it to press on nerves, which can cause pain in unrelated areas such as the back).
724:"Laparoscopic (keyhole) removal of the whole kidney and ureter: Information about your procedure from The British Association of Urological Surgeons (BAUS)
728:
257:. This is the first time a healthy kidney has been removed via this method, though it has been done in the past for nephrectomies carried out due to
929:
Ibrahim, Hassan N.; Foley, Robert; Tan, LiPing; Roger's, Tyson; Bailey, Robert F.; Guo, Hongfei; Gross, Cynthia R.; Matas, Arthur J. (2009-01-29).
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129:. Simon practiced the operation beforehand in animal experiments. He proved that one healthy kidney can be sufficient for urine excretion in
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A partial nephrectomy is performed with a patient under general anesthesia as well. A partial nephrectomy can be performed through an
435:
Partial nephrectomy offers the same chance of cure from the renal cell cancer as radical nephrectomy. This was confirmed in a recent
1550:
621:
Moll, F; Karenberg, A (August 2000). "Gustav Simon (1824-1877) and the development of nephrectomy: the surgeon and his intention".
1878:
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Comparing the
Oncologic Outcome of Elective Nephron-Sparing Surgery and Radical Nephrectomy for Low-Stage Renal Cell Carcinoma".
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For some illnesses, there are alternatives today that do not require the extraction of a kidney. Such alternatives include
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Li L, Lau WL, Rhee CM, Harley K, Kovesdy CP, Sim JJ, Jacobsen S, Chang A, Landman J, Kalantar-Zadeh K (Jan 14, 2014).
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101:. It is also done to remove a normal healthy kidney from a living or deceased donor, which is part of a
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Muzaale AD, Massie AB, Wang MC, Montgomery RA, McBride MA, Wainright JL, Segev DL (Feb 12, 2014).
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is often given to the patient after the surgery because of pain at the site of the incision. An
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was able to donate a kidney and have it removed through her vagina. The operation took place at
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Partial nephrectomy is the surgical removal of a kidney tumor along with a thin rim of normal
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the kidney for cancer operations. If the kidney is being removed for other causes, it can be
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372:, with the two aims of curing the cancer and preserving as much normal kidney as possible.
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Gohh, Reginald Y.; Morrissey, Paul E.; Madras, Peter N.; Mónaco, Anthony P. (2001-03-01).
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De Groote P, Van Cangh PJ, Stainier L, Feyaerts A, Njinou B, Lorge F; et al. (1998).
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Czerny HE (cited by
Herczel E): Ueber nierenextirpation bietr. Klin Khirurg 1890;6:485.
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800:
700:"Overview | Laparoscopic nephrectomy (including nephroureterectomy) | Guidance | NICE"
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Wotkowicz, Chad; Libertino, John A. (2007). "Renal cell cancer: radical nephrectomy".
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is the removal of a kidney and the entire ureter and a small cuff of the bladder for
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for those who are poor candidates for surgery, or partial nephrectomy if possible.
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increased kidney tumor detection, partial nephrectomy is performed more often.
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to reach the kidney. Depending on circumstances, the incision can also be made
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863:"Cleveland Clinic performs first transvaginal kidney removal, plans a second"
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Occasionally renal cell cancers can involve adjacent organs, including the
191:. For the open procedure, the surgeon makes an incision in the side of the
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1378:
Localized Renal Tumors: A Systematic Review and Meta-Analysis".
1061:"Risk of end-stage renal disease following live kidney donation"
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882:"Controversies in organ donation: the altruistic living donor"
141:
There are various indications for this procedure, including
97:, performed to treat a number of kidney diseases including
1170:"Guideline for Management of the Clinical T1 Renal Mass".
1014:"Risk of chronic kidney disease after cancer nephrectomy"
577:"Case of Encephaloid Disease of the Kidney, Removal, etc"
187:. A kidney can be removed through an open incision or by
113:
The first recorded nephrectomy was performed in 1861 by
1531:
Explanation of the surgery, the risks and the recovery
556:
1213:
Cause in
Patients with Localized cT1b Renal Masses".
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Al-Khalil, N.; Panchev, P.; Kumanov, Kh (1999). "".
600:"The First Nephrectomy and the First Cholectystomoy"
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1110:"Nutritional management of chronic kidney disease"
824:The Journal of the Louisiana State Medical Society
249:In January 2009, a woman who had previously had a
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183:The surgery is performed with the patient under
744:"Is adrenalectomy part of radical nephrectomy?"
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1526:MedlinePlus Medical Encyclopedia: Nephrectomy
549:Kelly, Howard A.; Burrage, Walter L. (eds.).
431:Cancer control, quality of life, and survival
8:
772:: CS1 maint: multiple names: authors list (
145:, a non-functioning kidney (which may cause
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931:"Long-term consequences of kidney donation"
564:. Baltimore: The Norman, Remington Company.
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1108:Kalantar-Zadeh K, Fouque D (Nov 2, 2017).
729:British Association of Urological Surgeons
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1298:Nephrectomies for Single Renal Tumors".
475:
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1521:Drawings of the steps of the procedure
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604:Bulletin of the Johns Hopkins Hospital
312:Before and after a partial nephrectomy
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33:Before and after a radical nephrectomy
18:
7:
1566:Tests and procedures involving the
935:The New England Journal of Medicine
886:Nephrology Dialysis Transplantation
575:Stoddard, Charles L. (9 Nov 1861).
354:
219:, and usually also the ipsilateral
75:
14:
732:, No. 17/063 (May 2017), pp. 1-8.
581:The Medical and Surgical Reporter
443:compared to radical nephrectomy.
1879:Extracorporeal shockwave therapy
1348:10.1111/j.1464-410X.2012.11122.x
1263:10.1111/j.1464-410X.2012.11112.x
552:"Wolcott, Erastus Bradley"
520:10.1111/j.1464-410X.2007.06825.x
849:Donor kidney removed via vagina
287:New England Journal of Medicine
598:Tinker, Martin B. (Aug 1901).
1:
1914:Pediatric surgical procedures
1496:10.1016/S0090-4295(00)00927-4
801:10.1016/S0022-5347(01)62049-4
276:with fluids is administered.
93:is the surgical removal of a
1737:Artificial urinary sphincter
1596:Percutaneous nephrolithotomy
1460:10.1016/j.eururo.2010.12.013
623:Journal of Medical Biography
559:American Medical Biographies
255:Johns Hopkins Medical Center
16:Surgical removal of a kidney
1924:Surgical removal procedures
1742:Urethral bulking injections
851:, BBC News, 3 February 2009
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1829:Voiding cystourethrography
1424:10.1016/j.juro.2013.01.030
1388:10.1016/j.juro.2012.10.026
1312:10.1016/j.juro.2007.03.038
1227:10.1016/j.juro.2009.12.030
1184:10.1016/j.juro.2009.07.004
861:Higgs R (March 30, 2009).
635:10.1177/096777200000800303
485:National Kidney Foundation
1018:Nature Reviews Nephrology
458:List of surgeries by type
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167:of the kidney or ureter.
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26:
1772:Urinary tract ultrasound
1077:10.1001/jama.2013.285141
179:Laparoscopic nephrectomy
1857:Urinary catheterization
1814:Radioisotope renography
1249:Association surgeons".
1030:10.1038/nrneph.2013.273
210:single port laparoscopy
1824:Retrograde urethrogram
1628:Kidney transplantation
1412:The Journal of Urology
1380:The Journal of Urology
1300:The Journal of Urology
1215:The Journal of Urology
1172:The Journal of Urology
789:The Journal of Urology
283:chronic kidney disease
180:
157:kidney transplantation
125:on August 2, 1869, in
1909:Nephrology procedures
1694:Suprapubic cystostomy
1126:10.1056/NEJMra1700312
987:"What Is Nephrectomy"
947:10.1056/NEJMoa0804883
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1661:Ureterosigmoidostomy
899:10.1093/ndt/16.3.619
189:laparoscopic surgery
143:renal cell carcinoma
301:Partial Nephrectomy
294:Partial nephrectomy
147:high blood pressure
1834:Urodynamic testing
1747:Cystourethrography
991:Urology Specialist
235:inferior vena cava
228:renal embolization
185:general anesthesia
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161:nephroureterectomy
115:Erastus B. Wolcott
1919:Surgical oncology
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1656:Urinary diversion
1336:BJU International
1251:BJU International
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417:renal cell cancer
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77:
74:
73:
68:
62:
61:
54:
48:
47:
42:
36:
35:
32:
24:
23:
15:
13:
10:
9:
6:
4:
3:
2:
1941:
1930:
1927:
1925:
1922:
1920:
1917:
1915:
1912:
1910:
1907:
1906:
1904:
1885:
1882:
1880:
1877:
1873:
1870:
1869:
1868:
1865:
1863:
1860:
1858:
1855:
1854:
1852:
1848:
1840:
1837:
1836:
1835:
1832:
1830:
1827:
1825:
1822:
1820:
1817:
1815:
1812:
1810:
1807:
1805:
1802:
1798:
1795:
1793:
1790:
1788:
1785:
1783:
1780:
1779:
1778:
1775:
1773:
1770:
1769:
1767:
1765:
1761:
1758:
1754:
1748:
1745:
1743:
1740:
1738:
1735:
1733:
1732:Urethroplasty
1730:
1728:
1725:
1723:
1720:
1718:
1715:
1714:
1712:
1710:
1706:
1700:
1697:
1695:
1692:
1690:
1687:
1686:
1684:
1682:
1678:
1672:
1669:
1667:
1664:
1662:
1659:
1657:
1654:
1652:
1649:
1648:
1646:
1644:
1640:
1634:
1631:
1629:
1626:
1624:
1621:
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1612:
1609:
1608:
1607:
1604:
1602:
1599:
1597:
1594:
1590:
1587:
1586:
1585:
1582:
1581:
1579:
1577:
1573:
1569:
1561:
1556:
1554:
1549:
1547:
1542:
1541:
1538:
1532:
1529:
1527:
1524:
1522:
1519:
1518:
1514:
1505:
1501:
1497:
1493:
1489:
1485:
1477:
1474:
1469:
1465:
1461:
1457:
1454:(4): 543–52.
1453:
1449:
1441:
1438:
1433:
1429:
1425:
1421:
1417:
1413:
1405:
1402:
1397:
1393:
1389:
1385:
1381:
1373:
1370:
1365:
1361:
1357:
1353:
1349:
1345:
1341:
1337:
1329:
1326:
1321:
1317:
1313:
1309:
1305:
1301:
1293:
1291:
1289:
1285:
1280:
1276:
1272:
1268:
1264:
1260:
1256:
1252:
1244:
1241:
1236:
1232:
1228:
1224:
1220:
1216:
1208:
1206:
1204:
1202:
1198:
1193:
1189:
1185:
1181:
1178:(4): 1271–9.
1177:
1173:
1165:
1163:
1161:
1157:
1151:
1148:
1143:
1139:
1135:
1131:
1127:
1123:
1119:
1115:
1111:
1104:
1101:
1096:
1092:
1087:
1082:
1078:
1074:
1071:(6): 579–86.
1070:
1066:
1062:
1055:
1052:
1047:
1043:
1039:
1035:
1031:
1027:
1023:
1019:
1015:
1008:
1005:
992:
988:
982:
979:
974:
970:
965:
960:
956:
952:
948:
944:
940:
936:
932:
925:
922:
917:
913:
909:
905:
900:
895:
891:
887:
883:
876:
873:
868:
864:
857:
854:
850:
845:
842:
837:
833:
830:(3): 119–23.
829:
825:
818:
815:
810:
806:
802:
798:
794:
790:
783:
780:
775:
769:
761:
757:
753:
749:
745:
738:
735:
731:
730:
725:
720:
717:
705:
701:
695:
692:
687:
683:
679:
675:
671:
667:
660:
657:
652:
648:
644:
640:
636:
632:
628:
624:
617:
614:
609:
605:
601:
594:
591:
587:(6): 126–127.
586:
582:
578:
571:
568:
562:
560:
553:
545:
542:
537:
533:
529:
525:
521:
517:
513:
509:
502:
499:
486:
482:
481:"Nephrectomy"
476:
474:
470:
463:
459:
456:
454:
451:
450:
446:
444:
442:
438:
437:meta-analysis
430:
428:
423:Complications
422:
420:
418:
413:
409:
405:
397:
395:
391:
384:
382:
375:
373:
371:
360:
351:
348:
346:
342:
338:
334:
332:
328:
325:
322:
320:
316:
309:
304:
299:
293:
291:
290:risk of CKD.
288:
284:
279:
275:
271:
264:
262:
260:
256:
252:
244:
242:
240:
236:
231:
229:
224:
222:
221:adrenal gland
218:
213:
211:
207:
202:
198:
194:
190:
186:
177:
170:
168:
166:
162:
158:
155:
150:
148:
144:
136:
134:
132:
128:
124:
120:
116:
108:
106:
104:
100:
99:kidney cancer
96:
92:
81:
72:
69:
67:
63:
59:
55:
53:
49:
46:
43:
41:
37:
30:
25:
20:
1671:Ureteroscopy
1666:Ureterolysis
1651:Ureterostomy
1622:
1618:Renal biopsy
1589:percutaneous
1490:(2): 252–6.
1487:
1483:
1476:
1451:
1447:
1440:
1415:
1411:
1404:
1379:
1372:
1342:(4): 580–8.
1339:
1335:
1328:
1303:
1299:
1257:(5): 731–8.
1254:
1250:
1243:
1218:
1214:
1175:
1171:
1150:
1117:
1113:
1103:
1068:
1064:
1054:
1021:
1017:
1007:
995:. Retrieved
993:. 2016-12-21
990:
981:
938:
934:
924:
889:
885:
875:
866:
856:
844:
827:
823:
817:
792:
788:
782:
768:cite journal
751:
747:
737:
727:
719:
709:28 September
707:. Retrieved
703:
694:
672:(5): 38–39.
669:
665:
659:
626:
622:
616:
607:
603:
593:
584:
580:
570:
558:
544:
511:
507:
501:
491:28 September
489:. Retrieved
484:
434:
426:
408:laparoscopic
401:
392:
388:
379:
367:
268:
251:hysterectomy
248:
232:
225:
214:
182:
160:
151:
140:
123:Gustav Simon
112:
90:
88:
1867:Lithotripsy
1819:Cystography
1782:Intravenous
1722:Urethrotomy
1717:Urethropexy
1623:Nephrectomy
1611:Nephroscopy
1584:Nephrostomy
1306:(1): 41–6.
795:(1): 24–7.
754:(2): 41–5.
385:Indications
278:Electrolyte
237:(IVC), the
206:morcellated
137:Indications
105:procedure.
91:nephrectomy
22:Nephrectomy
1903:Categories
1884:Urinalysis
1839:Cystometry
1804:CT urogram
1787:Retrograde
1699:Cystoscopy
1689:Cystectomy
1633:Nephropexy
1601:Nephrotomy
666:Khirurgiia
464:References
265:After care
127:Heidelberg
1792:Antegrade
1777:Pyelogram
1606:Endoscopy
1046:205513333
997:31 August
955:1533-4406
908:0931-0509
678:0450-2167
528:1464-410X
398:Procedure
259:pathology
171:Procedure
119:Wisconsin
1504:11182331
1468:21186077
1432:23337186
1396:23085064
1364:24800075
1356:22564425
1320:17574056
1271:22502641
1235:20171688
1192:19683266
1142:27499763
1134:29091561
1095:24519297
1038:24419566
973:19179315
916:11239042
836:10851826
809:10037359
686:11194631
651:35896849
643:10954921
536:17441916
447:See also
319:ICD-9-CM
40:ICD-9-CM
1764:Imaging
1756:General
1709:Urethra
1681:Bladder
1484:Urology
1086:4411956
964:3559132
760:9633127
412:robotic
376:History
337:D009392
197:midline
193:abdomen
109:History
58:D009392
1643:Ureter
1576:Kidney
1502:
1466:
1430:
1394:
1362:
1354:
1318:
1279:829345
1277:
1269:
1233:
1190:
1140:
1132:
1093:
1083:
1044:
1036:
971:
961:
953:
914:
906:
834:
807:
758:
684:
676:
649:
641:
561:
534:
526:
370:kidney
201:ureter
199:. The
131:humans
95:kidney
1850:Other
1360:S2CID
1275:S2CID
1138:S2CID
1042:S2CID
647:S2CID
357:[
350:5-554
239:colon
159:. A
154:donor
78:[
71:5-554
1500:PMID
1464:PMID
1428:PMID
1392:PMID
1352:PMID
1316:PMID
1267:PMID
1231:PMID
1188:PMID
1130:PMID
1091:PMID
1065:JAMA
1034:PMID
999:2017
969:PMID
951:ISSN
912:PMID
904:ISSN
832:PMID
805:PMID
774:link
756:PMID
711:2019
682:PMID
674:ISSN
639:PMID
532:PMID
524:ISSN
493:2019
404:open
331:MeSH
324:55.4
52:MeSH
45:55.5
1797:Gas
1492:doi
1456:doi
1420:doi
1416:189
1384:doi
1344:doi
1340:111
1308:doi
1304:178
1259:doi
1255:111
1223:doi
1219:183
1180:doi
1176:182
1122:doi
1118:377
1081:PMC
1073:doi
1069:311
1026:doi
959:PMC
943:doi
939:360
894:doi
828:152
797:doi
793:161
631:doi
516:doi
410:or
117:in
1905::
1498:.
1488:57
1486:.
1462:.
1452:59
1450:.
1426:.
1414:.
1390:.
1382:.
1358:.
1350:.
1338:.
1314:.
1302:.
1287:^
1273:.
1265:.
1253:.
1229:.
1217:.
1200:^
1186:.
1174:.
1159:^
1136:.
1128:.
1116:.
1112:.
1089:.
1079:.
1067:.
1063:.
1040:.
1032:.
1022:10
1020:.
1016:.
989:.
967:.
957:.
949:.
937:.
933:.
910:.
902:.
890:16
888:.
884:.
865:.
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766:{{
752:66
750:.
746:.
726:.
702:.
680:.
670:55
668:.
645:.
637:.
625:.
608:12
606:.
602:.
583:.
579:.
555:.
530:.
522:.
512:99
510:.
483:.
472:^
419:.
406:,
274:IV
223:.
212:.
133:.
89:A
1559:e
1552:t
1545:v
1506:.
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1458::
1434:.
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1366:.
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1322:.
1310::
1281:.
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1237:.
1225::
1194:.
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1144:.
1124::
1097:.
1075::
1048:.
1028::
1001:.
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918:.
896::
869:.
838:.
811:.
799::
776:)
762:.
713:.
688:.
653:.
633::
627:8
585:7
538:.
518::
495:.
361:]
82:]
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