C Netsch1, R Brüning, T Bach, A J Gross. 1. Department of Urology, Asklepios Hospital Barmbek, Ruebenkamp 220, 22291, Hamburg, Germany. c.netsch@asklepios.com
Abstract
PURPOSE: Nephron sparing surgery has been established as a standard treatment for renal masses smaller than 4 cm in diameter. The benefit of nephron sparing surgery may be hampered by new types of complications. In particular, postoperative gross hematuria due to the formation of renal artery pseudoaneurysm (RAP) can lead to clinical significant hemorrhage. We retrospectively investigated the occurrence of postoperative RAP in our own consecutive series of open/laparoscopic partial nephrectomies requiring transarterial angioembolization. METHODS: Open partial nephrectomy (OPN) was performed in 289 patients, and laparoscopic partial nephrectomy (LPN) in 40 patients. Six patients (1.82%) developed postoperative clinical symptomatic, persistent gross hematuria from RAP. Patient files were evaluated for preoperative, operative and postoperative data. RESULTS: First symptom presentation was observed at a median of 12.5 days (range 6-36) after surgery. Symptoms were flank pain, gross hematuria, dizziness/syncope and/or fever. Median postoperative blood transfusion rate was 3 units (range 0-8). RAP was proven with angiography in all patients. RAP was sufficiently occluded in all patients by using microcoils in a supraselective approach. Median follow-up was 23 months (range 10-37) without any episodes of hemorrhage/flank pain in each patient. CONCLUSIONS: RAP is a rare, but typical complication after partial nephrectomy. The clinical symptoms present with delay. Angiography identifies the origin of the bleeding and provides successful minimally invasive treatment.
PURPOSE: Nephron sparing surgery has been established as a standard treatment for renal masses smaller than 4 cm in diameter. The benefit of nephron sparing surgery may be hampered by new types of complications. In particular, postoperative gross hematuria due to the formation of renal artery pseudoaneurysm (RAP) can lead to clinical significant hemorrhage. We retrospectively investigated the occurrence of postoperative RAP in our own consecutive series of open/laparoscopic partial nephrectomies requiring transarterial angioembolization. METHODS: Open partial nephrectomy (OPN) was performed in 289 patients, and laparoscopic partial nephrectomy (LPN) in 40 patients. Six patients (1.82%) developed postoperative clinical symptomatic, persistent gross hematuria from RAP. Patient files were evaluated for preoperative, operative and postoperative data. RESULTS: First symptom presentation was observed at a median of 12.5 days (range 6-36) after surgery. Symptoms were flank pain, gross hematuria, dizziness/syncope and/or fever. Median postoperative blood transfusion rate was 3 units (range 0-8). RAP was proven with angiography in all patients. RAP was sufficiently occluded in all patients by using microcoils in a supraselective approach. Median follow-up was 23 months (range 10-37) without any episodes of hemorrhage/flank pain in each patient. CONCLUSIONS: RAP is a rare, but typical complication after partial nephrectomy. The clinical symptoms present with delay. Angiography identifies the origin of the bleeding and provides successful minimally invasive treatment.
Authors: Richard E Link; Sam B Bhayani; Mohammed E Allaf; Ioannis Varkarakis; Takeshi Inagaki; Craig Rogers; Li-Ming Su; Thomas W Jarrett; Louis R Kavoussi Journal: J Urol Date: 2005-05 Impact factor: 7.450
Authors: Francesco Chiancone; Maurizio Fedelini; Luigi Pucci; Domenico Di Lorenzo; Clemente Meccariello; Paolo Fedelini Journal: Curr Urol Date: 2017-05-30
Authors: Petr Dvorak; Petr Hoffmann; Milos Brodak; Josef Kosina; Jaroslav Pacovsky; Jan Raupach; Antonin Krajina Journal: Wideochir Inne Tech Maloinwazyjne Date: 2017-12-29 Impact factor: 1.195