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Intrarenal pseudoaneurysm after percutaneous nephrolithotomy at solitary kidney.

Ozturk H - Nephrourol Mon (2014)

Bottom Line: In the presented patient, serious retroperitoneal hemorrhage and hypotension in the preoperative and postoperative periods resulted in acute renal failure (ARF).It was first report of selective TAE in a patient with ARF due to post-PCNL pseudoaneurysm in solitary kidney.Super-selective segmental embolization was performed successfully in this case and was shown to be a reliable and efficient procedure.

View Article: PubMed Central - PubMed

Affiliation: Department of Urology, School of Medicine, Sifa University, Izmir, Turkey.

ABSTRACT

Introduction: Percutaneous nephrolithotomy (PCNL) is a standard, safe, and efficient method for removing large renal calculi. Despite development of endourologic equipment, complications of the PCNL are still prevalent. Even though therapeutic modalities such as mini-micro PCNL have been developed in recent years, the complications are a serious concern yet. The most important complication is hemorrhage. The hemorrhage may be either arterial or venous. Venous hemorrhage is usually treated conservatively whereas the arterial one might require transarterial embolization (TAE). Arterial hemorrhage may cause serious problems, especially in the patients with solitary kidney.

Case presentation: In the presented patient, serious retroperitoneal hemorrhage and hypotension in the preoperative and postoperative periods resulted in acute renal failure (ARF).

Conclusions: It was first report of selective TAE in a patient with ARF due to post-PCNL pseudoaneurysm in solitary kidney. Super-selective segmental embolization was performed successfully in this case and was shown to be a reliable and efficient procedure.

No MeSH data available.


Related in: MedlinePlus

Computed Tomography Substituted by Lower Calyx Reentry Catheter (red arrow) and Giant Retroperitoneal Hematoma (yellow arrow)
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fig12938: Computed Tomography Substituted by Lower Calyx Reentry Catheter (red arrow) and Giant Retroperitoneal Hematoma (yellow arrow)

Mentions: Under general anesthesia and after inserting a 6-Fr catheter in the left ureter, the patient was put in lithotomy position by placing cushions under his knees, iliac bones, and shoulder. The collector tract was visualized with contrast medium. An 18-gauge needle was advanced to the lower calyx. Stone-free standard PCNL procedure was performed with pneumatic lithotripter using low-pressure isotonic solution and semi-rigid Amplatz dilators under the guide of rigid nephroscope. A 20-Fr reentry was used as nephrostomy catheter. Hypotension and oliguria (400 mL/day) developed during the first 24 postoperative hours. The patient was supported with intravenous colloidal solution and blood transfusion. Abdominal computed tomography (CT) revealed retroperitoneal hematoma extending to the left fossa iliaca (Figure 2). Hb levels progressively decreased to 6.5 g/dL. Level of urea and creatinine were respectively 98 mg/dL and 5.5 mg/dL at the 48th postoperative hour. At the 72nd postoperative hour, level of urea and creatinine were 145 mg/dL and 9.3 mg/dL, respectively. The results of renal Doppler US showed a 28 mm thickness and heterogeneous parenchyma with grade II echogenicity. After consultation with nephrology department, the patient underwent hemodialysis. On the 96th postoperative hour, selective renal angiography was performed with presumed diagnosis of pseudoaneurysm. Pseudoaneurysm was found on the posterior segment of the left inferior renal artery (Figure 3). Segmental aneurysm was corrected by applying three simultaneous endocoils. Hemodialysis was done twice on the 120th and 144th postoperative hours. Following hemodialysis, urinary output increased from 3750 mL to 12000 mL, and creatinine level fell from 10 mg/dL to 1.3 mg/dL. The patient was discharged after recovery of his renal function. The findings of the patients are summarized in Table 1.


Intrarenal pseudoaneurysm after percutaneous nephrolithotomy at solitary kidney.

Ozturk H - Nephrourol Mon (2014)

Computed Tomography Substituted by Lower Calyx Reentry Catheter (red arrow) and Giant Retroperitoneal Hematoma (yellow arrow)
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4318009&req=5

fig12938: Computed Tomography Substituted by Lower Calyx Reentry Catheter (red arrow) and Giant Retroperitoneal Hematoma (yellow arrow)
Mentions: Under general anesthesia and after inserting a 6-Fr catheter in the left ureter, the patient was put in lithotomy position by placing cushions under his knees, iliac bones, and shoulder. The collector tract was visualized with contrast medium. An 18-gauge needle was advanced to the lower calyx. Stone-free standard PCNL procedure was performed with pneumatic lithotripter using low-pressure isotonic solution and semi-rigid Amplatz dilators under the guide of rigid nephroscope. A 20-Fr reentry was used as nephrostomy catheter. Hypotension and oliguria (400 mL/day) developed during the first 24 postoperative hours. The patient was supported with intravenous colloidal solution and blood transfusion. Abdominal computed tomography (CT) revealed retroperitoneal hematoma extending to the left fossa iliaca (Figure 2). Hb levels progressively decreased to 6.5 g/dL. Level of urea and creatinine were respectively 98 mg/dL and 5.5 mg/dL at the 48th postoperative hour. At the 72nd postoperative hour, level of urea and creatinine were 145 mg/dL and 9.3 mg/dL, respectively. The results of renal Doppler US showed a 28 mm thickness and heterogeneous parenchyma with grade II echogenicity. After consultation with nephrology department, the patient underwent hemodialysis. On the 96th postoperative hour, selective renal angiography was performed with presumed diagnosis of pseudoaneurysm. Pseudoaneurysm was found on the posterior segment of the left inferior renal artery (Figure 3). Segmental aneurysm was corrected by applying three simultaneous endocoils. Hemodialysis was done twice on the 120th and 144th postoperative hours. Following hemodialysis, urinary output increased from 3750 mL to 12000 mL, and creatinine level fell from 10 mg/dL to 1.3 mg/dL. The patient was discharged after recovery of his renal function. The findings of the patients are summarized in Table 1.

Bottom Line: In the presented patient, serious retroperitoneal hemorrhage and hypotension in the preoperative and postoperative periods resulted in acute renal failure (ARF).It was first report of selective TAE in a patient with ARF due to post-PCNL pseudoaneurysm in solitary kidney.Super-selective segmental embolization was performed successfully in this case and was shown to be a reliable and efficient procedure.

View Article: PubMed Central - PubMed

Affiliation: Department of Urology, School of Medicine, Sifa University, Izmir, Turkey.

ABSTRACT

Introduction: Percutaneous nephrolithotomy (PCNL) is a standard, safe, and efficient method for removing large renal calculi. Despite development of endourologic equipment, complications of the PCNL are still prevalent. Even though therapeutic modalities such as mini-micro PCNL have been developed in recent years, the complications are a serious concern yet. The most important complication is hemorrhage. The hemorrhage may be either arterial or venous. Venous hemorrhage is usually treated conservatively whereas the arterial one might require transarterial embolization (TAE). Arterial hemorrhage may cause serious problems, especially in the patients with solitary kidney.

Case presentation: In the presented patient, serious retroperitoneal hemorrhage and hypotension in the preoperative and postoperative periods resulted in acute renal failure (ARF).

Conclusions: It was first report of selective TAE in a patient with ARF due to post-PCNL pseudoaneurysm in solitary kidney. Super-selective segmental embolization was performed successfully in this case and was shown to be a reliable and efficient procedure.

No MeSH data available.


Related in: MedlinePlus