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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.