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Öcal O, Puhr-Westerheide D, Mühlmann M, Deniz S, Fabritius MP, Weinhold P, Wildgruber M, Ricke J, Seidensticker M. iRESCUE - Interventional embolization of Renal artEries after SurgiCal or traUmatic injury with hEmorrhage. Eur J Radiol 2021; 136:109540. [PMID: 33476964 DOI: 10.1016/j.ejrad.2021.109540] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 12/12/2020] [Accepted: 01/06/2021] [Indexed: 01/21/2023]
Abstract
OBJECTIVES To evaluate the efficacy and safety of urgent percutaneous embolization for the treatment of acute renal hemorrhage. MATERIALS AND METHODS All patients undergoing endovascular embolization at our hospital for bleeding from renal artery branches between January 2010 and June 2020 were retrospectively evaluated. Periprocedural characteristics, technical details, clinical outcomes, and complications were documented. RESULTS Seventy-six patients with a mean age of 67.3 ± 12.9 underwent 86 procedures. The most common cause of hemorrhage was iatrogenic (63/76), including 44 patients presenting after partial nephrectomy. Bleeding was successfully controlled in 80 of 86 procedures (92.8 % technical success), and clinical success (defined as control of bleeding with endovascular embolization) was achieved in 72 of 76 patients (94.5 %) with embolization, including seven patients undergoing re-intervention. In univariate analysis, risk factors for clinical failure were antiplatelet agents (p = 0.033), and technical failure (p < 0.001); and technical failure was the only significant risk factor in multivariate analysis. Only one patient (1.3 %) needed nephrectomy. AKI was seen after 16 (21 %) procedures, and preprocedural increased creatinine (≧1.8) and decreased GFR (<60) were risk factors for AKI (p = 0.022 and p = 0.020). In all patients except one, renal functions returned to baseline. One patient died because of pulmonary embolism (in-hospital mortality 1.3 %). CONCLUSION Interventional embolization is feasible, safe, and effective in the treatment of renal hemorrhages. Among others, the complication management with minimally invasive procedures allows urologists to safely perform partial nephrectomy even in patients with central, large, and endophytic tumors, thereby preserving kidney function in these patients.
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Affiliation(s)
- Osman Öcal
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | | | - Marc Mühlmann
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | - Sinan Deniz
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | | | - Philipp Weinhold
- Department of Urology, University Hospital, LMU Munich, Munich, Germany
| | - Moritz Wildgruber
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | - Jens Ricke
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | - Max Seidensticker
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany.
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[AN EXPERIENCE OF PARTIAL NEPHRECTOMY IN A PATIENT WITH VON WILLEBRAND DISEASE]. Nihon Hinyokika Gakkai Zasshi 2019; 110:196-200. [PMID: 32684581 DOI: 10.5980/jpnjurol.110.196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
A 28-year-old male visited a nearby hospital with chief complaint of bilateral back pain and fever. He was diagnosed with a right complex renal cyst (Bosniak classification, IIF) with a kidney stone and was referred to our hospital. We first suspected an incarcerated kidney stone and performed flexible transurethral lithotomy; however, his symptoms did not improve. Blood examination revealed prolonged APTT; subsequently, he was diagnosed with von Willebrand disease (VWD). Because he experienced pain due to the hemorrhagic renal cyst, we performed partial nephrectomy. Preoperatively, we supplemented the von Willebrand factor (VWF) based on the VWF activity in the patient. Although intraoperative bleeding was well controlled, he developed bleeding from pseudoaneurysms on the postoperative day (POD) 6. We immediately performed transarterial embolization along with VWF replenishment. VWF supplementation was discontinued on POD 14, and the patient was discharged on POD 23. Since then, he has not experienced a bleeding recurrence or pain. In patients with VWD, the perioperative administration of desmopressin or VWF is recommended. Although several reports showed that surgeries involving these treatments are safe, only three cases with VWD, including the present case where the patient underwent partial nephrectomy, have been reported. In the present case, postoperative bleeding occurred despite exhibiting adequate perioperative VWF activity. Thus, bleeding complications in patients with VWD undergoing partial nephrectomy must be considered and should be carefully followed up.
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Nouhaud FX, Williams M, Arnfield E, Perera ML, Cho J, Esler R, Coughlin G. Is postoperative Doppler ultrasonography useful for the early detection of asymptomatic pseudoaneurysm and prevention of haemorrhagic complications after partial nephrectomy? BJU Int 2018; 122 Suppl 5:15-21. [DOI: 10.1111/bju.14485] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
| | - Michael Williams
- Department of Urology; Royal Brisbane and Women's Hospital; Brisbane Qld Australia
| | - Evyn Arnfield
- Department of Radiology; Royal Brisbane and Women's Hospital; Brisbane Qld Australia
- School of Medicine; University of Queensland; Brisbane Qld Australia
| | - Marlon Lakmal Perera
- Department of Urology; Royal Brisbane and Women's Hospital; Brisbane Qld Australia
| | - Jonathan Cho
- Department of Urology; Royal Brisbane and Women's Hospital; Brisbane Qld Australia
| | - Rachel Esler
- Department of Urology; Royal Brisbane and Women's Hospital; Brisbane Qld Australia
- Wesley Urology Clinic; Wesley Hospital; Brisbane Qld Australia
| | - Geoff Coughlin
- Department of Radiology; Royal Brisbane and Women's Hospital; Brisbane Qld Australia
- Wesley Urology Clinic; Wesley Hospital; Brisbane Qld Australia
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The Assessment of the Risk of Acute Kidney Injury in Patients Undergoing an Urgent Endovascular Treatment Due to Severe Renal Bleeding. Cardiovasc Intervent Radiol 2017; 41:398-405. [DOI: 10.1007/s00270-017-1800-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Accepted: 09/21/2017] [Indexed: 12/20/2022]
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Impact of Anticoagulant and Antiplatelet Drugs on Perioperative Outcomes of Robotic-assisted Partial Nephrectomy. Urology 2017; 99:118-122. [DOI: 10.1016/j.urology.2016.09.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Revised: 08/06/2016] [Accepted: 09/07/2016] [Indexed: 01/20/2023]
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González J, Cózar JM, Gómez A, Fernández-Pérez C, Esteban M. Nephron-sparing surgery in renal cell carcinoma: current perspectives on technical issues. Curr Urol Rep 2016; 16:6. [PMID: 25633842 DOI: 10.1007/s11934-014-0475-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Surgical resection remains the standard treatment for renal cell carcinoma. Although historically the concept of wide excision of the affected kidney dictated surgical thinking for more than half a century, a better understanding of the biology of this tumor, standardized staging, and changing patterns of presentation permit today a refined management approach with nephron-sparing surgery, thus limiting potential long-term morbidity by maximizing the preservation of functional renal parenchyma. This paper aims to review the current status of nephron-sparing surgery for solid renal masses with an emphasis on indications, preoperative assessment, and operative technical issues, summarizing the most recent existing data on the subject.
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Affiliation(s)
- Javier González
- Servicio de Urología, Hospital Central de la Cruz Roja San José y Santa Adela Madrid, Avda. de Reina Victoria 22-26, 28003, Madrid, Spain,
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Fu D, Li P, Xu F, Tian F, Xu XF, Wei ZF, Zhang ZY, Ge JP, Cheng W. Ultrasound-guided open nephron sparing surgery without renal artery occlusion for central renal tumors. ACTA ACUST UNITED AC 2016; 36:118-120. [PMID: 26838751 DOI: 10.1007/s11596-016-1552-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2015] [Revised: 12/03/2015] [Indexed: 11/26/2022]
Abstract
From January 2008 to January 2013, 11 patients with central renal tumors underwent ultrasound-guided open nephron sparing surgery (ONSS) without renal artery occlusion. We removed the lesions, and the cut edges of the tumors were negative. Thus, we deduced that ultrasound-guided ONSS is suitable for the cases with obscure tumor boundary or multiple lesions. It could achieve the purpose of thoroughly removing lesions, as well as to expand the application range of nephron sparing surgery.
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Affiliation(s)
- Dian Fu
- Department of Urology, Nanjing Jinling Hospital, Nanjing University School of Medicine, Nanjing, 210002, China
| | - Ping Li
- Department of Urology, Nanjing Jinling Hospital, Nanjing University School of Medicine, Nanjing, 210002, China
| | - Feng Xu
- Department of Urology, Nanjing Jinling Hospital, Nanjing University School of Medicine, Nanjing, 210002, China
| | - Feng Tian
- Department of Urology, Nanjing Jinling Hospital, Nanjing University School of Medicine, Nanjing, 210002, China
| | - Xiao-Feng Xu
- Department of Urology, Nanjing Jinling Hospital, Nanjing University School of Medicine, Nanjing, 210002, China
| | - Zhi-Feng Wei
- Department of Urology, Nanjing Jinling Hospital, Nanjing University School of Medicine, Nanjing, 210002, China
| | - Zheng-Yu Zhang
- Department of Urology, Nanjing Jinling Hospital, Nanjing University School of Medicine, Nanjing, 210002, China
| | - Jing-Ping Ge
- Department of Urology, Nanjing Jinling Hospital, Nanjing University School of Medicine, Nanjing, 210002, China
| | - Wen Cheng
- Department of Urology, Nanjing Jinling Hospital, Nanjing University School of Medicine, Nanjing, 210002, China.
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Fardoun T, Chaste D, Oger E, Mathieu R, Peyronnet B, Rioux-Leclercq N, Verhoest G, Patard J, Bensalah K. Predictive factors of hemorrhagic complications after partial nephrectomy. Eur J Surg Oncol 2014; 40:85-9. [DOI: 10.1016/j.ejso.2013.11.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2013] [Revised: 10/27/2013] [Accepted: 11/03/2013] [Indexed: 10/26/2022] Open
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Huber J, Herpel E, Jakobi H, Hadaschik BA, Pahernik S, Hohenfellner M. Two decades' experience with a prospective biobank for urologic oncology: research, clinical care, and the patients' view. Urol Oncol 2013; 31:990-6. [DOI: 10.1016/j.urolonc.2012.01.016] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2012] [Revised: 01/26/2012] [Accepted: 01/31/2012] [Indexed: 11/26/2022]
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Laydner H, Autorino R, Spana G, Altunrende F, Yang B, Khanna R, White MA, Isac W, Hillyer S, Haber GP, Stein RJ, Kaouk JH. Robot-assisted partial nephrectomy for sporadic ipsilateral multifocal renal tumours. BJU Int 2011; 109:274-80. [DOI: 10.1111/j.1464-410x.2011.10319.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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Huber J, Pahernik S, Hallscheidt P, Sommer CM, Wagener N, Hatiboglu G, Haferkamp A, Hohenfellner M. Selective Transarterial Embolization for Posttraumatic Renal Hemorrhage: A Second Try is Worthwhile. J Urol 2011; 185:1751-5. [DOI: 10.1016/j.juro.2010.12.045] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2010] [Indexed: 11/15/2022]
Affiliation(s)
- Johannes Huber
- Departments of Urology and Radiology (PH, CMS), University of Heidelberg, Heidelberg, Germany
| | - Sascha Pahernik
- Departments of Urology and Radiology (PH, CMS), University of Heidelberg, Heidelberg, Germany
| | - Peter Hallscheidt
- Departments of Urology and Radiology (PH, CMS), University of Heidelberg, Heidelberg, Germany
| | - Christof M. Sommer
- Departments of Urology and Radiology (PH, CMS), University of Heidelberg, Heidelberg, Germany
| | - Nina Wagener
- Departments of Urology and Radiology (PH, CMS), University of Heidelberg, Heidelberg, Germany
| | - Gencay Hatiboglu
- Departments of Urology and Radiology (PH, CMS), University of Heidelberg, Heidelberg, Germany
| | - Axel Haferkamp
- Departments of Urology and Radiology (PH, CMS), University of Heidelberg, Heidelberg, Germany
| | - Markus Hohenfellner
- Departments of Urology and Radiology (PH, CMS), University of Heidelberg, Heidelberg, Germany
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