Presentation Authors: Doo Yong Chung*, Jong Soo Lee, AHMAD ALMUJALHEM, Ali Raheem, Ki don Chang, Jin Hyeong Jeon, Don Gu Lee, Jang Hwan Kim, Sung Jun Hong, Byung Ha Chung, Young deuk Choi, Koon Ho Rha, seoul, Korea, Republic of
Introduction: Partial nephrectomy (PN) represents the current surgical standard for T1 tumors. With the wider application of nephron-sparing surgery, potentially life-threatening postoperative hemorrhage complication has be reported. Selective artery embolization (SAE) is a good treatment in these patients. We aimed to evaluate characteristics and clinical outcomes in patients undergoing SAE.
Methods: A retrospective review of our institutional PN database from July 2005 to October 2018 was performed. Of them, we evaluated patients who underwent SAE after PN. Patients' characteristics and clinical outcomes were analyzed.
Results: A total of 2076 cases underwent PN were evaluated. SAE was performed in 41 (1.97%) patients who underwent Open PN (19/1171, 1.62%), laparoscopic PN (4/60, 6.67%), Robot assisted PN (18/845, 2.37%), respectively. The median period from PN to SAE was 12 days (interquartile range 8-24). The most common symptom of 31(75.61%) patients presented with gross hematuria. Other symptoms were flank pain (3/41, 7.32%). Asymptomatic 7 patients represented pseudoaneurysm in follow up CT. The main reason for SAE on angiography was pseudoanuerysm (32/41, 78.05%). And there were arteriovenous fistula (5/41, 12.20%), contrast extravasation (4/41, 9.76%). SAE was performed using endovascular coils or n-butyl-2-cyanoacrylate (NBCA). Technical and clinical successes were achieved in all patients (100%). There were no episodes of bleeding recurrence during the follow-up period. The embolization group and the control group showed 89.8% and 92.2% eGFR preservation after PN, respectively. There was no statistical difference between the two groups. (p=0.376) There was no statistically significant difference in surgical methods and baseline characteristics such as age, BMI, eGFR (estimated glomerular filtration rate) between two groups. In the embolization group, feature of renal tumors showed endophytic (28/41, 68.29%) and posterior. (25/41, 60.98%). But R.E.N.A.L score and PADUA score did not differ between the two groups.
Conclusions: SAE is a successful method of controlling postoperative bleeding while preserving renal function after PN. Urologists should also pay attention to renorrhaphy of PN for renal masses located endophytic and posterior.