Abstract
Laparoscopic partial nephrectomy has recently emerged as a minimally invasive treatment for small- to moderate-sized renal tumors. Renal artery pseudoaneurysms (RAPs) have been well-reported in patients with renal trauma or who have undergone percutaneous urological procedures, including biopsy, nephrostomy and percutaneous nephroureterolithotomy. However, RAP following laparoscopic partial nephrectomy for central renal tumor is a rare but serious, potentially life-threatening complication. In total, two patients underwent laparoscopic partial nephrectomy at The First Affiliated Hospital of Zhejiang University School of Medicine (Hangzhou, China) for central renal tumors that had developed gross hematuria several weeks following the surgical procedures. The formation of RAPs was confirmed by contrast-enhanced computed tomography scans. Superselective embolizations of the renal artery branches were successfully performed to treat these two patients. In the current report, the etiology, diagnosis and management of RAPs are discussed.
Highlights
Laparoscopic nephron‐sparing surgery has been increasingly performed by urologists for patients with renal tumors, and its complications have received increasing attention [1]
These results suggested the formation of a Renal artery pseudoaneurysms (RAPs) (Fig. 1B)
Rupture and hemorrhage of the renal artery or renal artery branch may lead to a hematoma, which may be wrapped by the surrounding tissue and form a cystic cavity that connects with the artery, a condition termed as RAP [3]
Summary
Laparoscopic nephron‐sparing surgery has been increasingly performed by urologists for patients with renal tumors, and its complications have received increasing attention [1]. The enhanced CT scan found a 6‐cm hematoma on the edge of the right kidney and a 2.2‐cm cystic shadow bound to the surgical area of the right kidney with enhancement These results suggested the formation of a RAP (Fig. 1B). The hematuria was controlled and the results of the CT scan performed two weeks following the embolization indicated that the RAP had contracted (Fig. 1C). A contrast‐enhanced CT scan revealed a ~3‐cm cystic shadow bound to the center of the upper pole of the left kidney, with enhancement similar to that of the surrounding renal arteries, which suggested the formation of a RAP (Fig. 1E). On day 37 following surgery, the patient underwent selective embolization of the left renal artery branches. This procedure was successful and the patient's hematuria was controlled. The results of the CT scan performed one week following the embolization indicated that the RAP had contracted (Fig. 1F)
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