Partial Nephrectomy Managed with Selective Embolization


Partial Nephrectomy Managed with Selective Embolization


Journal of nephrology and urology has been recently launched a case study related to the Delayed Severe Bleeding Following Partial Nephrectomy Managed with Selective Embolization by  R. B. Nerli, Department of Urology, has submitted a case report to our journal who is the author of the prestigious journal. Here we are explaining the importance of case report.

Partial nephrectomy (PN) is the surgical technique of choice in the treatment of renal tumors in clinical stage T1a (≤ 4 cm), and also in selected cases in stage T1b and T2. Complications following PN have been extensively studied and reported in the literature. Among the complications, postoperative haemorrhage is one with potentially serious consequences. It is estimated that, including immediate and delayed bleeding, its incidence is between 4 and 6% after laparoscopic PN, and about 1.6% after open PN. Very few studies have focused on the diagnosis and treatment of delayed bleeding, the one that occurs after the patient is discharged. The occurrence of delayed bleeding after PN is rare, and it is usually attributed to the presence of artery pseudoaneurysms (AP). The incidence of symptomatic AP is over 0.43% after open PN, and 1.7-7.5% after laparoscopic PN. The real incidence of AP could be much higher as most of the AP do not get to produce clinical manifestations. We reported a case of delayed post-operative bleeding following open partial nephrectomy and managed by angio-embolization of the arterial pseudoaneurysms.

Partial nephrectomy has become the treatment of choice for localized renal tumors. Despite the relatively low incidence of bleeding after partial nephrectomy, it remains one of the most serious complications, and this is especially so for centrally located tumors. Several studies have examined several factors in relation to hemorrhage following partial nephrectomy, including patient and demographic factors, operative techniques, and tumor related parameters. Van Poppel et al., in their study of 76 open partial nephrectomies, suggested that tumors that were large in size and centrally located had an increased risk of postoperative hemorrhage. Similarly, Ramani et al. reported that the incidence of postoperative bleeding was higher in patients with tumors that were centrally located and with deeper infiltration.

Delayed bleeding or hemorrhage following partial nephrectomy occurs due to arterial pseudoaneurysms. Selective vascular embolization is the treatment of choice for patients with symptoms of severe bleed in a hemodynamically stable patient.

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