Superselective Renal Artery Embolization in the Treatment of Iatrogenic Bleeding into the Urinary Tract
Tomasz Ząbkowski, Piotr Piasecki, Henryk Zieliński, Andrzej Wieczorek, Krzysztof Brzozowski, Piotr Zięcina
(Department of Urology, Military Institute of Medicine, Warsaw, Poland)
Med Sci Monit 2015; 21:333-337
The aim of this study was to evaluate the efficacy of superselective renal artery embolization in patients with bleeding into the urinary system.
Material and Methods: From 2007 to 2012, 20 patients were treated with superselective renal artery embolization for bleeding after percutaneous nephrolithotomy (PCNL), nephron-sparing surgery (NSS), including 1 patient with AVF after PCNL. During the procedure, embolization material was injected through a microcatheter to stop the bleeding. Embolization materials included a mixture of cyanoacrylate and lipiodol, embolization coils, and Spongostan. Clinical evaluation included remission of hematuria and normalization of blood morphotic elements.
Results: The cause of bleeding into the urinary tract was damage to vessels (all cases): with coexisting false aneurism (8 cases); with coexisting arterio-venus fistula (1 case); and with coexisting intrarenal hematoma (3 cases). The bleeding occurred 2–5 days after PCNL and NSS, and 10 days after PCNL with AVF. The mean hematocrit level was 22%–24%. Technical success was achieved in 20 cases. Clinical success was achieved in 19 cases. One patient with hematuria after PCNL with AVF needed a second endovascular treatment to stop bleeding.
Conclusions: Superselective renal artery embolization is an effective procedure in the treatment of iatrogenic bleeding into the urinary tract after PCNL and NSS.
Keywords: Angiography, Aneurysm, False, Catheterization, Embolization, Therapeutic - methods, Hematocrit, Hematuria - therapy, Hemorrhage - therapy, Humans, Lithotripsy - methods, Nephrons - surgery, Nephrostomy, Percutaneous - methods, Renal Artery - pathology, Retrospective Studies, Urinary Tract - pathology