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The use of mannitol in partial and live donor nephrectomy: an international survey

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Abstract

Purpose

Animal studies have shown the potential benefits of mannitol as renoprotective during warm ischemia; it may have antioxidant and anti-inflammatory properties and is sometimes used during partial nephrectomy (PN) and live donor nephrectomy (LDN). Despite this, a prospective study on mannitol has never been performed. The aim of this study is to document patterns of mannitol use during PN and LDN.

Materials and methods

A survey on the use of mannitol during PN and LDN was sent to 92 high surgical volume urological centers. Questions included use of mannitol, indications for use, physician responsible for administration, dosage, timing and other renoprotective measures.

Results

Mannitol was used in 78 and 64 % of centers performing PN and LDN, respectively. The indication for use was as antioxidant (21 %), as diuretic (5 %) and as a combination of the two (74 %). For PN, the most common dosages were 12.5 g (30 %) and 25 g (49 %). For LDN, the most common doses were 12.5 g (36.3 %) and 25 g (63.7 %). Overall, 83 % of centers utilized mannitol, and two (percent or centers??) utilized furosemide for renoprotection.

Conclusions

A large majority of high-volume centers performing PN and LDN use mannitol for renoprotection. Since there are no data proving its value nor standardized indication and usage, this survey may provide information for a randomized prospective study.

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Acknowledgments

To, Guazzoni G. (Department of Urology, San Raffaele Hospital, Milan Italy), Schips L. (Department of Urology, S.Pio da Pietrelcina Hospital, Vasto, Italy), Harper J (University of Washington Seattle, USA), Romanò A.L. (Department of Urology, Ospedale Luigi Sacco, Milan, Italy), Chun F.K. (Department of Urology, University of Hamburg, Germany), Sulser T. (Clinic for Urology, University Hospital, Zurich, Switzerland), Klinkl M. (Department of Urology, Medical University Vienna, Vienna, Austria), Kavoussi L. (Long Island, NY, USA), Joyce A. (St James’ University Hospital, Leeds, UK), Lucan M. (Clinical Institute of Urology and Renal Transplantation Cluj- Napoca, Romania), Leike S. (Klink und Poliklinik für Urologie Dresden, Germany) and Porena M. (Department of Medical Surgical Specialties and Public Health, Section of Urology and Andrology, Università di Perugia, Italy), Sabaté S. and Vernetta D. (Department of Anaesthesiology, Fundaciò Puigvert, Barcelona, Spain for their contribution to this survey.

Author information

Authors and Affiliations

  1. Department of Urology, Fundació Puigvert, Universitat Autònoma de Barcelona, Cerdanyola del Vallès, Spain

    M. Cosentino, A. Breda, F. Sanguedolce & H. Villavicencio

  2. Department of Urology, Columbia University, New York City, NY, USA

    J. Landman

  3. Department of Urology, University Leipzig, Leipzig, Germany

    J.-U. Stolzenburg

  4. Department of Urology, University Federico II of Naples, Naples, Italy

    P. Verze

  5. SLK Kliniken Urology Department, Heidelberg University, Heilbronn, Germany

    J. Rassweiler

  6. Department of Urology, University Hospitals Leuven, Leuven, Belgium

    H. Van Poppel

  7. Department of Urology, Medical University of Vienna, Vienna, Austria

    H. C. Klingler

  8. Department of Urology, Paracelsus Medical University Salzburg, Salzburg, Austria

    G. Janetschek

  9. Department of Urology, San Bassiano Hospital, Bassano del Grappa, Italy

    A. Celia

  10. Denver Health Medical Center, Tony Grampsas Cancer Center, University of Colorado Health Sciences Center, Boulder, CO, USA

    F. J. Kim

  11. Department of Urology, University Hospital, Inselspital, Berne, Switzerland

    G. Thalmann

  12. General Hospital Hall in Tyrol, Eisenstadt, Austria

    U. Nagele

  13. Department of Urology, Università di Pisa, Pisa, Italy

    A. Mogorovich

  14. Mannheim Medical Center, University of Heidelberg, Mannheim, Germany

    C. Bolenz

  15. Klinikum Sindelfen-Boblingen, University of Tueblingen, Tueblingen, Germany

    T. Knoll

  16. Department of Urology, San Luigi Hospital, Orbassano, Turin, Italy

    F. Porpiglia

  17. Department of Urology, Hospital Universitario Infanta Sofia, Madrid, Spain

    M. Alvarez-Maestro

  18. U.O. Urologia 2, Azienda Ospedaliera Universitaria Pisana, Pisana, Italy

    F. Francesca

  19. Department of Urology, Ospedali Riuniti Bergamo, Bergamo, Italy

    F. Deho

  20. University of Chicago, Chicago, IL, USA

    S. Eggener

  21. Department of Urology CHU Henri Mondor, Créteil, France

    C. Abbou

  22. Department of Urology, UCSF, San Francisco, CA, USA

    M. V. Meng

  23. University of Southern California, Los Angeles, CA, USA

    M. Aron

  24. AMC University Hospital, Amsterdam, The Netherlands

    P. Laguna

  25. Clinic of Urology, Medical University, Sofia, Bulgaria

    D. Mladenov

  26. Department of Urology, Università Cattolica del Sacro Cuore, Rome, Italy

    A. D’Addessi

  27. Department of Urology, Università Tor Vegata, Rome, Italy

    P. Bove

  28. Department of Urology, Alma Mater Studiorum Università di Bologna, Bologna, Italy

    R. Schiavina

  29. Department of Urology, European Institute of Oncology, Milan, Italy

    O. De Cobelli

  30. Hannover Medical School, Hannover, Germany

    A. S. Merseburger

  31. Department of Urology, University of Graz, Graz, Austria

    O. Dalpiaz

  32. Department of Urology, University Hospital Nijmegen, Nijmegen, The Netherlands

    F. C. H. D’Ancona

  33. Duke University, Durham, NC, USA

    T. J. Polascik

  34. Department of Urology, Diakoniekrankenhaus Academic Teaching Hospital, Rotenburg, Germany

    R. Muschter

  35. Department of Urology, Stanford University, Stanford, CA, USA

    T. J. Leppert

Authors
  1. M. Cosentino
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  2. A. Breda
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  3. F. Sanguedolce
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  4. J. Landman
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  5. J.-U. Stolzenburg
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  6. P. Verze
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  7. J. Rassweiler
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  8. H. Van Poppel
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  9. H. C. Klingler
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  10. G. Janetschek
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  11. A. Celia
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  12. F. J. Kim
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  13. G. Thalmann
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  14. U. Nagele
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  15. A. Mogorovich
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  16. C. Bolenz
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  17. T. Knoll
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  18. F. Porpiglia
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  19. M. Alvarez-Maestro
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  20. F. Francesca
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  21. F. Deho
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  22. S. Eggener
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  23. C. Abbou
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  24. M. V. Meng
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  25. M. Aron
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  26. P. Laguna
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  27. D. Mladenov
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  28. A. D’Addessi
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  29. P. Bove
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  30. R. Schiavina
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  31. O. De Cobelli
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  32. A. S. Merseburger
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  33. O. Dalpiaz
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  34. F. C. H. D’Ancona
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  35. T. J. Polascik
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  36. R. Muschter
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  37. T. J. Leppert
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  38. H. Villavicencio
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Corresponding authors

Correspondence to M. Cosentino or A. Breda.

Appendix: Survey

Appendix: Survey

Use of mannitol in partial nephrectomy and living donor nephrectomy

Please answer the questions by adding an X to the right answer

  1. 1.

    Institution (Name of the Institution, City, Country)

  2. 2.

    Type of Institution

    1. a.

      Academic

    2. b.

      Peripheral University Affiliate

    3. c.

      Public Hospital (or County Hospital)

    4. d.

      Private Hospital

    5. e.

      Other

  1. 3.

    Faculty number in the department

Number

  1. 4.

    Number of beds of the Urology Department

Number

  1. 5.

    Is mannitol (or other similar agent) used in partial or/and donor nephrectomy at your institution?

    1. a.

      Yes

    2. b.

      No

If you answer YES, please proceed to question 7.

If you answer NO please proceed to question 6.

  1. 6.

    Reason why mannitol is not available at your institution

    1. a.

      Not part of the internal protocol

    2. b.

      Do not believe in its benefits

    3. c.

      Other

  1. 7.

    At your institution, mannitol is used for

    1. a.

      Partial nephrectomy

    2. b.

      Living donor nephrectomy

    3. c.

      Both

  1. 8.

    What is the reason of using mannitol during these surgeries?

    1. a.

      Kidney protector/Antioxidan

    2. b.

      Stimulate diuresis

    3. c.

      Both

    4. d.

      Other

  1. 9.

    Who does indicate mannitol administration?

    1. a.

      Urologist

    2. b.

      Nephrologist

    3. c.

      Anesthetist

    4. d.

      Other

In case of partial nephrectomy

  1. 10.

    Dosage

    1. a.

      12.5 g

    2. b.

      25 g

    3. c.

      Other

  1. 11.

    Timing

    1. a.

      Before clamping

    2. b.

      After clamping

    3. c.

      Other

  1. 12.

    Other kidney protector agent

In case of living donor nephrectomy

  1. 13.

    Dosage

    1. a.

      12.5 g

    2. b.

      25 g

    3. c.

      Other

  1. 14.

    Timing

    1. a.

      Before clamping

    2. b.

      After clamping

    3. c.

      Other

  1. 15.

    Other kidney protector agent

  2. 16.

    How many partial nephrectomies are performed at your institution per year?

    1. a.

      <10

    2. b.

      Between 10 and 20

    3. c.

      >20

    4. d.

      >50

    5. e.

      >100

  1. 17.

    How many live donor nephrectomies have you performed at your institution?

    1. a.

      <10

    2. b.

      Between 10 and 20

    3. c.

      >20

    4. d.

      >50

    5. e.

      >100

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Cosentino, M., Breda, A., Sanguedolce, F. et al. The use of mannitol in partial and live donor nephrectomy: an international survey. World J Urol 31, 977–982 (2013). https://doi.org/10.1007/s00345-012-1003-1

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  • DOI: https://doi.org/10.1007/s00345-012-1003-1

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