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28 January 2015 : Clinical Research

Superselective Renal Artery Embolization in the Treatment of Iatrogenic Bleeding into the Urinary Tract

Tomasz ZąbkowskiABCDEF, Piotr PiaseckiABCF, Henryk ZielińskiAEF, Andrzej WieczorekCD, Krzysztof BrzozowskiACD, Piotr ZięcinaBCE

DOI: 10.12659/MSM.892112

Med Sci Monit 2015; 21:333-337

Abstract

BACKGROUND: 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, Lithotripsy - methods, Nephrons - surgery, Nephrostomy, Percutaneous - methods, Renal Artery - pathology, Urinary Tract - pathology

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Medical Science Monitor eISSN: 1643-3750
Medical Science Monitor eISSN: 1643-3750