Superselective Renal Artery Embolization Research Articles

Influencing Factors of Massive Hemorrhage and High-Grade Renal Vascular Injury after PCNL: A Retrospective Comparative Study.

Severe hemorrhage after percutaneous nephrolithotomy (PCNL) is a rare but alerting event. In this study, we report the factors affecting massive hemorrhage after PCNL, various levels of vascular damage during renal angiography, and the therapeutic effect of superselective renal artery embolization (SRAE). Patients and Methods. A retrospective analysis was performed on the data of 69 patients with postoperative PCNL hemorrhage who underwent SRAE from January 2010 to March 2021. Inclusion criteria for all cases were failure of conservative treatment for severe renal hemorrhage after surgery and then treatment with SRAE. In addition, 98 patients without significant hemorrhage after PCNL were randomly selected as the control group. All clinical data are confirmed by imaging and laboratory examinations. We performed univariate and multivariate analyses to find risk factors of massive hemorrhage and high-grade renal vascular injury after PCNL. A total of 69 patients underwent angiography, 64 of which received SRAE due to positive hemorrhages detected by angiography. Urinary tract infection (OR (95% CI) = 11.214 (2.804∼44.842)), high blood pressure (OR (95% CI) = 5.686 (1.401∼23.083)), and no hydronephrosis (OR (95% CI) = 0.189 (0.049∼0.724)) are the most important factors leading to massive hemorrhage after PCNL. In patients who need SRAE after hemorrhage, high-grade vascular injury (grade III) is related to advanced age and decreased hemoglobin. During the perioperative period of PCNL, patients with a risk of hypertension, urinary tract infection, and no hydronephrosis should be strengthened to monitor their high risk of postoperative hemorrhage. For patients with postoperative hemorrhage, we can use the patient's age and decreased hemoglobin before and after operation for analysis. In this way, individualized assessment can greatly improve the efficiency of SRAE treatment.

Superselective renal arterial embolization for severe postpercutaneous nephrolithotomy haemorrhage: clinical characteristics and risk factors for initial failure.

To identify the clinical characteristics of patients who underwent superselective renal arterial embolization (SRAE) after percutaneous nephrolithotomy (PCNL) and to explore the risk factors for failed initial SRAE after PCNL. Patients who underwent SRAE for severe haemorrhage following PCNL between January 2014 and December 2020 were included in the study. The clinical data of those patients and the parameters and characteristics of the perioperative PCNL and SRAE procedures were collected and analysed. A total of 243 patients were included in this study. A total of 139 patients (57.2%) had a pseudoaneurysm, 25 (10.3%) had an arteriovenous fistula, 50 (20.6%) patients had both a pseudoaneurysm and an arteriovenous fistula, and 29 (11.9%) had an arterial laceration. In 177 patients with single percutaneous access, 125 (70.6%) patients exhibited nontract haemorrhage, and 55 (31.1%) patients exhibited multiple bleeding sites. In 66 patients with multiple percutaneous access, 44 (66.7%) patients exhibited nontract haemorrhage, and 32 (48.5%) patients exhibited multiple bleeding sites. The decrease in Hb before SRAE was 41.4 ± 19.8g/L. The mean time between PCNL surgery and initial SRAE was 6.4 ± 4.9days. Serum creatinine was increased after the SRAE procedure. Initial SRAE was successful in 229 (94.2%) patients and failed in 14 (5.8%) patients. Multivariate regression demonstrated that hydronephrosis < 20mm, total ultrasonographic guidance, solitary kidney, previous ipsilateral renal surgery, PCNL duration > 90min and multiple bleeding sites were potential risk factors for initial embolization failure. Percutaneous access was not the most important reason for post-PCNL severe haemorrhage. SRAE is effective for the treatment of severe haemorrhage following PCNL; however, several factors have an impact on the success of initial SRAE. Additionally, the SRAE procedure may affect renal function.

Superselective Renal Artery Embolization for Serious Renal Hemorrhage after Percutaneous Renal Biopsy in a Young Male.

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Superselective renal arterial embolization in treatment for severe renal hemorrhage after flexible ureterorenoscopy and laser lithotripsy (FURSL).

Life-threatening renal hemorrhage after flexible ureterorenoscopy and laser lithotripsy (FURSL) is a rare complication. We aim to review our unit's experience with super-selective renal artery embolization as therapeutic options for such patients. From January 2015 to November 2021, total 1125 patients underwent the FURSL procedures in our unit. Patients with life-threatening renal hemorrhage were reviewed and the information of peri-operative, operative and post-operative were recorded. Of the 1125 patients who underwent FURSL procedure, two patients with life-threatening renal hemorrhage were diagnosis; the age is 67 and 42 years old, respectively. Preoperative imaging examination showed that two patients had upper ureteral stone and renal stone ranging in size from 1.2 to 3.0 cm. Female patient placed the D-J stent for two weeks before FURSL. After the operation, both patients had the massive gross hematuria, significant drop of hemoglobin (Hgb), blood pressure lowering and needed to transfusion. CT scan showed that the male patient had an intrarenal hematoma. All these two were treated by super-selective renal artery embolization and had a successful outcome. Life-threatening renal hemorrhage after FURSL is a rare and severe complication. Super-selective renal artery embolization is a safe and effective method for the treatment of patients with severe renal hemorrhage, preserving healthy renal parenchyma and renal function.

Percutaneous transcatheter super-selective renal arterial embolization with N-butyl cyanoacrylate for iatrogenic renal hemorrhage

BackgroundTo evaluate the safety and efficacy of percutaneous transcatheter super-selective renal arterial embolization (SRAE) with N-butyl cyanoacrylate (NBCA) for iatrogenic renal hemorrhage. MethodsBetween January 2014 and December 2019, 45 patients (including 18 patients with coagulopathy), who underwent percutaneous transcatheter SRAE with NBCA for iatrogenic renal hemorrhage at our institution, were retrospectively reviewed. The technical success rate, clinical success rate, and embolization-related complications were analyzed. The values of estimated glomerular filtration rate (eGFR), serum creatinine (sCr), and serum urea (sUr) were analyzed at the time of pre-SRAE, post-SRAE, and last follow-up to evaluate the effects of NBCA-based SRAE on renal function. ResultsDiagnostic renal arteriography revealed contrast extravasation in 18 patients and pseudoaneurysms in 27 patients. NBCA mixed with iodized oil in a 1:2–1:4 ratio was the sole embolic agent. No procedure-related mortality or major complications occurred. The technical and clinical success rates were both 100%. The values of eGFR, sCr and sUr were not found to be significantly different between pre-SRAE, post-SRAE and last follow-up (eGFR: 91.52 ​± ​21.17 vs. 90.98 ​± ​22.11 vs. 92.14 ​± ​23.51 ​mL/min/1.73 ​m2, p ​= ​0.729; sCr: 74.73 ​± ​11.08 vs. 75.27 ​± ​12.43 vs. 73.95 ​± ​10.14 ​μmol/L, p ​= ​0.543; sUr: 5.69 ​± ​0.84 vs. 5.71 ​± ​0.96 vs. 5.70 ​± ​0.79, p ​= ​0.515, respectively). ConclusionsPercutaneous transcatheter SRAE with NBCA is a safe and effective treatment modality for iatrogenic renal hemorrhage with no deterioration of renal function.

Volume preservation of a shattered kidney after blunt trauma by superselective renal artery embolization.

PURPOSE We examined whether superselective embolization of the renal artery could be effectively employed to preserve traumatic kidneys and assessed its clinical outcomes. METHODS Between December 2015 and November 2019, 26 patients who had American Association for the Surgery of Trauma grade V traumatic shattered kidneys were identified. Among them, a retrospective review was conducted of 16 patients who underwent superselective renal artery embolization for shattered kidney. The mean age was 41.2 ± 15.7 years, and the mean follow-up duration was 138.2 ± 140.1 days. Patient data including procedure details and clinical outcomes were reviewed, and the preserved volume of kidney parenchyma was calculated. RESULTS Bleeding control was achieved in 13 (81%) patients and kidney preservation was achieved in 11 (79%). There was no mortality, and the median intensive care unit stay was 1.5 days. The mean volume of remnant kidney was 122.3 ± 66.0 cm3 (70%) on the last follow-up computed tomography. The estimated glomerular filtration rate was not significantly changed after superselective renal artery embolization. CONCLUSION Superselective renal artery embolization using a microcatheter for the shattered kidney effectively controlled hemorrhage in acute stage trauma and enabled kidney preservation.

Safety and Effectiveness of Medical Therapy and Surgical Intervention for Renal Angiomyolipoma Associated With Tuberous Sclerosis Complex.

Our study aimed to evaluate the effect of daily oral dose of everolimus in the treatment of patients with tuberous sclerosis complex (TSC) associated with renal angiomyolipoma (RAML), and the feasibility and safety of surgical treatment approach. We retrospectively investigated a total of 13 patients diagnosed of TSC-associated renal angiomyolipoma (TSC-RAML) who were scheduled for everolimus therapy. At 3-9 months after starting everolimus therapy, 4 of the study patients were symptomatic and underwent partial renal resection surgery. Two of these surgeries were performed open nephron sparing surgery (NSS) after TAE (Trans-arterial embolization), while the remaining 2 underwent robot-assisted partial nephrectomy (RAPN). A multi-slice helical CT scan performed among all the patients every 3months, which was used to measure the volume and the density of the lesion. Follow-up CT images revealed a significant reduction (P < .05) in the RAML volume, at a rate ranging from 11.6 to 42.5%, in response to everolimus therapy (10mg/day) in TSC-RAML patients. Further, a significant decrease in the mean tumor density (P < .05), as compared to its baseline value, was also observed. Super-selective renal arterial embolization done prior to NSS was effective in reducing the intraoperative bleeding and stabilizing the patient during the NSS procedure: mean warm ischemia time was 29.5minutes (range 18-40minutes) and mean intraoperative bleeding volume was 275mL (range 200-350mL). Post-surgical (both NSS and RAPN) follow-up showed a favorable perioperative morbidity profile with good renal functional preservation. At the end of 2years, all patients were well, with no signs of progression or recurrence of the condition, and demonstrated normal renal function. The results suggested oral everolimus as an effective non-invasive therapy to treat TSC-RAML patients. Post mTOR inhibitor therapy, NSS and RAPN are preferred mode of surgical intervention in symptomatic patients. TAE prior to NSS is beneficial.

Non-Permanent Transcatheter Proximal Renal Artery Embolization for a Grade 5 Renal Injury with Delayed Recanalization and Preserved Renal Parenchymal Enhancement

&lt;p&gt;Super-selective renal artery embolization is an increasingly popular technique for the management of traumatic, low-grade renal trauma. When performed in distal arterial branches, this intervention enables tissue preservation and arrest of hemorrhage, but it may not be practical in cases of multifocal, high-grade renal injuries. In such cases, surgical nephrectomy remains the more common treatment modality to ensure hemodynamic control. We present the unique case of a patient who presented in hemorrhagic shock following a major trauma that resulted in a grade 5 renal injury treated with complete renal artery embolization using Gelfoam, resulting in hemodynamic stabilization. Interestingly, imaging 1 month after embolization revealed residual enhancement of the inferior pole of the kidney, suggesting reconstitution of flow and partial renal salvage. Ultimately, transcatheter “nephrectomy” with careful selection of a temporary embolic agent may serve as a safe and efficient alternative to surgical nephrectomy with the added possibility of preserving partial renal perfusion and function in the emergent setting.&lt;/p&gt;

Superselective Renal Artery Embolization Management of Post-percutaneous Nephrolithotomy Hemorrhage and Its Methods

Objective: The purpose of this study was to evaluate the therapeutic efficacy and safety of superselective renal arterial embolization (SRAE) in the treatment of patients with renal hemorrhage after percutaneous nephroscopy (PCNL). In addition, embolization techniques and embolization materials during operation were also worthy of further discussion.Methods: From February 2015 to December 2019, clinical data of 49 consecutive patients with renal hemorrhage after PCNL were retrospectively analyzed. Demographic and clinical data of patients were recorded, changes in serum creatinine values were analyzed, and the safety and efficacy of TAE were evaluated. Clinical experience was also recorded.Results: A total of 49 patients underwent angiography, of which 46 patients received SRAE due to positive hemorrhagic foci detected by angiography, and the technical success rate of 46 patients was 100%. Among the three patients who did not receive embolization, one patient underwent nephrectomy, and two patients improved with conservative treatment, with a clinical success rate of 98%. There was no statistically significant difference between serum creatinine before PCNL and 7 days after SRAE (101.6 ± 36.5 to 100.5 ± 27.1 μmol/L; P = 0.634), and no significant change was observed in serum creatinine at the last follow-up (99.4 ± 34 μmol/L, P = 0.076). No major complications occurred after embolization.Conclusions: SRAE is safe and effective in patients with renal hemorrhage after PCNL. The experience of interventional therapy and the choice of embolization materials in this study may provide certain benefits for the treatment of patients with renal hemorrhage after PCNL.

Impact of Superselective Renal Artery Embolization on Renal Function and Blood Pressure.

Objectives:To evaluate the effect of superselective renal artery embolization in terms of renal function and blood pressure, to compare the results between groups with different embolization extents, and to analyze risk factors of entire study population for postprocedural acute kidney injury (AKI).Materials and Methods:The inclusion criteria were patients who underwent renal artery embolization from January 2009 to December 2019, with available serum creatinine and blood pressure data. The exclusion criteria were non-selective embolization of main renal artery, AKI before embolotherapy, and follow-up of less than one month. According to the extent of embolization, the patients were divided into two groups: Group A (1 segment) and Group B (2–4 segments).Results:A total of 48 patients were enrolled. There was a significant difference between pre- and postprocedural estimated glomerular filtration rate (p = 0.030). There were no significant difference between pre- and postprocedural blood pressure. The incidence of postprocedural AKI in group B was significantly higher than that in group A (p = 0.044). There was no significant difference in the incidence of the worsening of hypertension between the two groups. Chronic kidney disease and high embolization grade were predictive for postprocedural AKI (p = 0.012, 0.021).Conclusion:Superselective embolization appears to be a safe procedure, but meticulous attention for AKI is required for patients who underwent embolization of more than one segmental artery. An attempt to minimize the extent of devascularization should be pursued to avoid postprocedural complications.

Decreased hemoglobin as a quantifiable indicator of renal arterial embolization in post-percutaneous nephrolithotomy hemorrhage

To determine quantifiable indicators for post-percutaneous nephrolithotomy (PCNL) renal arterial embolization. A total of 2043 patients who underwent PCNL from September 2012 to March 2018 were reviewed retrospectively. Post-operative hemorrhage patients were extracted and divided into two groups according to treatment methods (conservative methods or super-selective renal arterial embolization [SRAE]). Demographic characteristics and hemorrhage outcomes were compared between the two groups by univariable analysis. Multivariable logistic regression was used to reveal the association between hemorrhage outcome factors and SRAE. A receiver operating characteristic (ROC) curve was drawn to determine the optimized cut-off value for SRAE. We identified 71 patients who had post-PCNL hemorrhage. Seventeen and 54 patients comprised the SRAE and conservative groups, respectively. No significant differences in demographic characteristics were found between the two groups. Univariate analysis showed that the differences in decreased hemoglobin (Hb), hemorrhage types, and transfusion were significant between the two groups (p < 0.001). Multivariable analysis showed that the decreased Hb was closely associated with the risk of SRAE. The ROC curve showed that an adjusted Hb decrease of 3.45 g/dL was an optimum indicator (AUC = 0.925). Decreased Hb is an indicator for SRAE after PCNL. When the adjusted decrease in Hb is ≥ 3.45 g/dL, SRAE should be performed regardless of the manifestations of hemorrhage.

Initial Experience With the Microvascular Plug in Selective Renal Artery Embolization

To evaluate the safety and efficacy of the microvascular plug (MVP) for selective renal artery embolization. Retrospective review was performed on a cohort of 6 patients undergoing renal artery embolization using the MVP between July 2015 and August 2018. Patients' demographics, indication for embolization, technical details of the embolization procedure, and clinical events were gathered from the patients' electronic medical records. The patients underwent selective renal artery embolization with a MVP for iatrogenic vascular injuries (n = 3), traumatic vascular injuries (n = 2), and for elective embolization of an angiomyolipoma (n = 1), in native kidneys (n = 4) or in renal allografts (n = 2). Immediate occlusion of the feeding artery was achieved with 1 MVP device in 4 patients. In 1 patient, a second MVP was needed, and in another patient, additional 0.018-inch microcoils were used to completely occlude the injured artery. Technical success was achieved in all patients. The volume of the resulting renal infarction was estimated less than 5% of the renal volume. No other procedure-related complications occurred. The MVP is a safe and effective device allowing superselective renal artery embolization. Therefore, we recommend the MVP as a valuable embolic in superselective renal artery embolization. Additionally, a single device is sufficient in most cases, potentially reducing the cost, duration, and radiation exposure of the procedure.

Complications of MPCNL for renal calculi in children and the managements

In the past 10 years, we treated about 1500 children with renal calculi. Minimally invasive percutaneous nephrolithotomy (MPCNL) nowadays is the treatment of choice for most renal stones. To evaluate the occurrence and management of complications following minimally invasive percutaneous nephrolithotomy (MPCNL) for renal calculi in children. The clinical data of 158 children including 119 males and 39 females treated by MPCNL were reviewed from January 2010 to January 2018 in Hunan children’s hospital. The mean age was 6.65 years (range 6 months to 18 years). Of 158 cases, 41 cases had single renal calculus, 117 multiple renal calculi (25 cases were bilateral), and 11 cases with a history of ipsilateral lithotrity. The mean stone size was 23.53±7.25mm (range 15 to 43). The mean operative time was 58.6±15.8min (range 32 to 93). Stone-free rate was 82.9% (131/158) after a single procedure. 10 patients had insignificant fragments and were followed without any intervention; 17 required additional procedure (RIRS in 6, second MPCNL in 11) and 15 of these were completely stone free, resulting in an overall success rate of 92.4% three months later. The postoperative hospital stay was 6 days. 3 children suffered postoperative bleeding caused by laceration at the calyceal neck whose hemoglobin was as little as 65g/L and recovered after transfusion (Clavien Ⅱ). Renal vein trauma was caused by a deep puncture during the echo-guided PCN procedure in 2 cases, treated by clamping the nephrostomy catheter. 1 patient had to undergo superselective renal artery embolization for her uncontrollable bleeding (Clavien Ⅲ). Obvious urinary extravasation occurred in 2 cases, resolved by double J stent placement, anti-infection, hemostasis and other symptomatic treatment (Clavien Ⅱ). Delayed phase Ⅱ lithotripsy was carried out in 1 case because of failure in establishing the renal channel. Ureteropelvic junction obstruction was observed in 1 case at his postoperative visit and treated by ureterocalicostomy after diagnosis (Clavien Ⅲ). 14 patients had postoperative fever, treated with sensitive antibiotics (Clavien Ⅱ). There was a total of 24 complications (15.1%), with the most severe complications being Clavien Ⅲ. No patients showed urosepsis, abdominal visceral injury, pleural effusion, pneumothorax, and renal arteriovenous fistula and other severe complications. This data show that MPCNL is a safe and effective procedure for renal calculi in children. However, the complications cannot be ignored. Sufficient preoperative preparation and careful perioperative safety control should be required. Skillful and prudent operation, renal pelvic pressure control, monitoring life symptoms, levels of fluid, infection control and staged in select cases are the key to reducing and preventing complications.

Superselective renal artery embolization for treatment of urological hemorrhage after partial nephrectomy in a solitary kidney.

Embolization is a well-known and accepted form of treatment for bleeding caused by a multitude of renal procedures. We present a case of a 66-year-old woman who had a history of left nephrectomy for clear cell carcinoma seven years previously and now presented with a 6 cm tumor involving the solitary kidney. She underwent partial laparoscopic nephrectomy with removal of the tumor on the right kidney. In the immediate postoperative period she had important and persistent hematuria associated with tachycardia, hypotension, and lumbar pain. After showing signs of hemodynamic instability, she was taken to the catheter laboratory where selective angiography of the right kidney was performed. Superselective embolization with controlled release of fibrous microcoils was performed. The superselective renal embolization technique performed on an emergency basis to control hemorrhage after a urological procedure is effective and achieves lasting resolution of symptoms.

Failure of initial superselective renal arterial embolization in the treatment of renal hemorrhage after percutaneous nephrolithotomy: A respective analysis of risk factors.

Superselective renal arterial embolization (SRAE) is a well-established method for the treatment of severe hemorrhage following percutaneous nephrolithotomy (PCNL). However, there remains a significant rate of failures requiring repeat SRAE or nephrectomy. To identify risk factors for initial treatment failure of SRAE, the data of patients who had undergone SRAE for severe bleeding due to PCNL between August 2005 and June 2016 were retrospectively analyzed. A total of 98 patients required SRAE for bleeding control following PCNL. Renal arteriography revealed pseudoaneurysm in 65 patients, arteriovenous fistula in 6 patients, and a combination of both in 11 patients. Free extravasation was observed in 11 patients; 8 of these patients exhibited coexisting pseudoaneurysm. Vascular aberration/tortuosity was identified in 10 patients. A total of 17 patients (17.3%) experienced initial treatment failure and underwent repeat SRAE. Multivariate analysis identified percutaneous tract size, number of bleeding sites and vascular aberration/tortuosity as significant predictors of initial treatment failure. The results from the present study suggested that repeated SRAE is preferred for patients who have experienced initial treatment failure with recurrent hemorrhage following PCNL. Large tract size, multiple bleeding sites and renal vascular aberration/tortuosity were significantly associated with increased risk of initial treatment failure of SRAE. These data may assist interventional radiologists in the planning and execution of SRAE in the treatment of PCNL.

Superselective renal artery embolization for bleeding complications after percutaneous renal biopsy: a single-center experience

ObjectiveThis study aimed to determine if superselective renal artery embolization is a safe and effective method of treating bleeding complications after percutaneous renal biopsy.MethodsFrom January 2006 to December 2017, 43 patients (22 men and 21 women, mean age: 44.5 ± 14.0 years) underwent angiography for post-biopsy bleeding complications following percutaneous biopsy. Patients underwent angiography and superselective artery embolization. We recorded serum creatinine and hemoglobin values to assess the effect of embolization.ResultsSuccessful embolization was achieved in all patients. There was a pseudoaneurysm in 10 cases, arteriovenous fistula in eight, contrast media extravasation in 16, arteriovenous fistula combined with contrast media extravasation in five, and pseudoaneurysm combined with arteriovenous fistula in four. The embolic substance was a microcoil only or combined with a gelatin sponge. The mean creatinine value was not different at 1 day and 1 week after embolization compared with before embolization. Mean hemoglobin values were significantly higher at 1 day and 1 week after embolization than before embolization.ConclusionsSuperselective renal artery embolization is a safe and effective treatment for post-biopsy bleeding complications after percutaneous renal biopsy. Lumbar or iliolumbar artery angiography is necessary if renal arteriography shows no signs of hemorrhage.

Causes of bleeding due to arterial injury after minimally invasive percutaneous nephroclithotomy

Objective To investigate the causes of bleeding due to arterial injury after minimally invasive percutaneous nephrolithotomy (mPCNL). Methods We retrospectively analyzed the clinical data of 2 980 patients who underwent ultrasound-guided mPCNL between January 2012, and January 2017, in our hospital. Among them, 1 853 were male and 1 127 were female. Age from17 to 76 years old, average age was (45.7±24.1) years. The calculi size was from 1.5 to 4.2 cm, average of (2.62±1.08)cm. There were 2 478 kidney stones and 502 cases of ureteral calculi. Besides, 727 cases with mild hydronephrosis, 1 971 cases with moderate hydronephrosis, 282 cases with severe hydronephrosis; 480 patients with urinary tract infection; 103 patients with renal empyema or acute renal failure; 63 patients with cardiovascular and cerebrovascular stent implantation; 214 patients with diabetes mellitus. Results In this study, all of the patients were established percutaneous renal tract successfully, indwelling drainage tube (6±2)d, and postoperative hemorrhage in 117 cases, of which 29 patients suffered from bleeding due to arterial injury and DSA showed 20 cases with acute arterial injury, 5 cases with pseudo-aneurysm, and 4 cases with arteriovenous fistula. However, all these cases were rehabilitated after the treatment of super-selective renal artery embolization. The rates of arterial injury of renal calyx access and pelvic access were 0.39% (10/2 535) and 4.27% (19/445), respectively. The rate of arterial injury in renal pelvic access was significantly higher than renal calyx access of PCNL (P 0.05). All the percutaneous renal accesses were dilated with Amplatz sheaths, and the arterial injury rate of F16-18 and F20-22 tracts in the calyx access were 0.35% (5/1 446), 0.46% (5/1 089), respectively, with no significant difference in size of calyx access associated with rate of arterial injury after mPCNL(P>0.05). The arterial injury rates of F16-18 and F20-22 tracts in the pelvic access were 1.98% (5/253) and 7.29% (14/192), respectively. There was significant difference in the size of the pelvic access in the rate of arterial injury after mPCNL(P 0.05). Conclusions The puncture of the renal pelvis and size of renal pelvis tract significantly increased the probability of postoperative bleeding due to arterial injury. Key words: Percutaneous nephrolithotomy; Rate of arterial injury; Super-selective renal artery embolization; Precise puncture

Analysis and treatment of delayed hemorrhage after partial nephrectomy

Objective: To explore the causes of delayed hemorrhage after partial nephrectomy and its prevention and treatment methods. Methods: Clinical data for 64 cases of patients who received partial nephrectomy from August of 2010 to December of 2015 were retrospectively analyzed; whereas, 3 cases of patients (4.7%) had delayed hemorrhage, including 1 case of male patient and 2 cases of female patients. Then, compared them with patients with no hemorrhage to explore the risk factors for hemorrhage after partial nephrectomy. Results: Three cases of patients showed a large volume of gross hematuria in 7-22 days (the average was 16.3 days) after partial nephrectomy, with blood pressure and hemoglobin (HGB) decreased. 2 cases of patients with hemorrhage were given blood transfusion and conservative treatment, and patients’ conditions were improved obviously. The other patient was given superselective renal artery embolization (SRAE), with renal arteriography indicating the presence of pseudoaneurysm. Hematuria disappeared after surgery. In comparison with the non-hemorrhage group, warm ischemia time was longer in the hemorrhage group, and the difference was of statistical significance ( p < .05). Conclusions: Hemorrhage occurred after partial nephrectomy is mostly delayed. Once the type of complications happens, it is required to provide a timely treatment. Super-selective renal artery embolization (SRAE) is a safe and effective treatment method for hemorrhage after partial nephrectomy.

Discussion on the operative time of two stage soft ureteroscope lithotripsy for hemorrhagic embolism after percutaneous nephrolithotomy

Objective To investigate the the operative time of two stage soft ureteroscope lithotripsy for hemorrhagic embolism after percutaneous nephrolithotomy(PCNL). Methods The clinical data of 1 patient with massive hemorrhage after PCNL who treated with superselective renal artery embolization and ureteral soft lens were analyzed. Results The patient with postoperative bleeding after PCNL was treated with superselective renal artery branch embolization, after 30d embolization, the holmium laser lithotripsy under the soft ureteroscope for ureteral calculi was performed, and the renal pelvis mucosa smooth, no bleeding and scar formation were intraoperative visible. After operation, the stone was removed basically, and the double J tube was removed 2 weeks after operation. The patient had no special discomfort and the renal function was normal. Conclusion Postoperative 14-30d is a relatively safe time to perform flexible ureteroscopic lithotripsy for super selective renal artery embolization in the treatment of patient with massive hemorrhage after PCNL. Key words: Nephrostomy, percutaneous; Postoperative hemorrhage; Embolization therapeutic; Ureteroscopes; Lrthoripsy

Analysis of repeated renal arteriography after percutaneous nephrolithotomy.

To review the clinical data of the patients who required repeated renal arteriography following initial super-selective renalartery embolization (SRAE) after Percutaneous Nephrolithotomy (PCNL) and to analyze the reasons for the failure. We retrospectively reviewed the data of the patients who underwent repeat renal arteriography after PCNL for persistent or recurrent severe hemorrhage from August 2001 through August 2015 at our hospital. Total of 427 SRAEs were performed in 369 patients who had undergone PCNL. 21 patients had repeated renal arteriography. Among them, 12 required 2 sessions, 5 required 3 sessions, 1 required 4 sessions, and 3 required 5 sessions. In those 37 repeated renal arteriography, 7 were due to missed pseudoaneurysm, 5 for recanalization of the embolized vessels, and finding of new renal vascular lesions in 22. These new findings included new pseudoaneurysm in sixteen, new arterio-venous fistula (AVF) in two, combination of new pseudoaneurysm and AVF in four, and no identifiable abnormity in three. Except for the missed pseudoaneurysm and the recanalization of the embolized vessels, new renal vascular lesion was the major reason for the repeated arteriography in our hospital. The cause of these new renal vascular lesions was unknown. The lesion might be missed during the initial arteriography due to arterial spasm. Progressive deterioration of the injured vessel integrity could be the other possibility.