Open intervascular nephron-sparing surgery for pyelocaliceal transitional cell carcinoma in solitary kidney planned with contrast-enhanced multidetector CT

A 69-year-old man presented with a tumor involving the right renal pelvis and the middle and lower calyces in a solitary kidney. The patient was determined to preserve left renal function. Intervascular nephron-sparing surgery (NSS) was planned. A contrast-enhanced multidetector computed tomography (MDCT) was performed, providing 3-D reconstructions of the renal artery and collecting system in regard to the tumor. Two trunks of the anterior branch of the renal artery directed to the lower and middle parenchymal segments were identified. After dissection of the renal vessels, the anterior branch of the renal artery was identified. The trunks directed to the middle and lower segments were ligated and sected, producing an ischemic area. In cold ischemia, the renal pelvis and the middle and lower segments and calyces were ablated. An anastomosis between the ureter and the upper calyx was performed. Thirty days after surgery, serum creatinine was 3 mg/dl.