Hemorrhage Following Percutaneous Renal Surgery: Characterization Of Angiographic Findings

Main Category: Urology / Nephrology
Article Date: 05 Sep 2008 - 4:00 PDT

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UroToday.com - If there is only one journal you read this month the Journal of Endourology contains a plethora of excellent scientific articles including award winning papers from the World Congress of Endourology Meeting 2007. This paper is one of the first-prize winners and demonstrates that angioembolization should be the first line of management for bleeding following percutaneous renal access surgery.

Major hemorrhage following percutaneous renal access surgery, while uncommon, usually results from arterial pseudoaneurysm, and 95% of these are effectively identified and treated with angiography and embolization.

These are the findings of the Long Island Jewish Group in review of over 4,000 percutaneous renal access procedures over a period of 23 years. The incidence of bleeding requiring angioembolization was highest with a percutaneous upper tract transitional cell carcinoma (3.2%) and lowest for the percutaneous antegrade endopyelotomy (0.8%). Percutaneous stone extraction was associated with only a 1.2% rate of bleeding requiring embolization. Half of the angiographic findings revealed a pseudoaneurysm while the other half were almost equally divided between AV fistulas and contrast extravasation. The findings of this study support angioembolization as the key to management of these postoperative complications.

Richstone L, Reggio E, Ost MC, Seideman C, Fossett LK, Okeke Z, Rastinehad AR, Lobko I, Siegel DN, Smith AD.
J Endourol. 2008 Jun;22(6):1129-35.
doi:10.1089/end.2008.0061

Reported by UroToday.com Contributing Editor Elspeth M. McDougall, MD, FRCSC

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