Warming up to ischemia

摘要

As a practitioner of urology, it is daunting not to accept the common surgical dogma preached to us for decades that renal ischemia is harmful. The deleterious impact of renal ischemia has been significantly magnified during the last 3 decades. While it was originally accepted that up to 30 minutes of warm ischemia may be safely tolerated, the upper limit of acceptable renal ischemia is now in a downward spiral, with suggestions that every single minute of renal ischemia is harmful in the short and long term.1'2 The intolerance shown toward ischemia has even led to significant changes in surgical approaches such as selective clamping of the renal microvasculature alone as well as nonclamping techniques.3'4 The obvious question that comes to mind is do we have concrete evidence that temporary, clamp induced renal ischemia in the context of partial nephrectomy translates into adverse long-term renal outcomes? The answer is no.