Pathological spectrum of nephrectomies in a general hospital

To first categorize a series of nephrectomies according to underlying pathology, as practised in a major general hospital in the north of Jordan, and then compare the results with published figures for Western countries. Also, to create standards for future evaluation of nephrectomies performed by laparoscopy.

The hospital and pathological records of 423 consecutive nephrectomies performed at Princess Basma Teaching Hospital in the north of Jordan during the period of 1991 to 2000 were reviewed.

Benign disease led to surgery in 298 cases, of which 161 were secondary to infection-related conditions. Malignancy resulted in the removal of 125 kidneys. The rate of nephrectomy for benign conditions has declined during the last few years in comparison with that for malignant conditions. Patients operated on for benign diseases were younger [mean age, 38.4 years] than those with malignant tumours [mean age, 46.7 years].

The mean age of patients undergoing surgery for benign and malignant disease was lower than in publications from Western countries. The frequency of nephrectomy performed for tuberculosis, hydatid disease, and xanthogranulomatous pyelonephritis is still higher than the rates published in Western countries. There is a remarkably low frequency of upper urothelial carcinoma compared with Western countries, probably due to environmental differences and genetic susceptibilities. Malignant renal tumours tend to affect people at a remarkably young age in Jordan, which is thought to be a reflection of the high proportion of young people. Nephrectomy for malignant disease had a higher rate of complications (16.8%) than for benign conditions [9.4%; p less than 0.0228]. The re-operation rate was 3.1% for all patients who underwent nephrectomy. The overall 30-day mortality rate was 0.9%. Both screening and education programmes are needed to decrease the rate of nephrectomy for preventable conditions.