Functional and Morphological Effects of Postpercutaneous Nephrolithotomy Superselective Renal Angiographic Embolization - 23/08/11
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Résumé |
Objectives |
To evaluate the functional and morphological effects of postpercutaneous nephrolithotomy (PCNL) superselective renal angiographic embolization.
Methods |
Between January 1995 and March 2006, superselective renal angiography was needed to control severe bleeding after 41 of 4095 PCNL procedures (1%). We evaluated the short-term effects of embolization after 3 months with renal ultrasonography (RUS), dimercaptosuccinic acid (DMSA) renal scan, and estimation of serum creatinine. We evaluated long-term morphological and functional effects with RUS, DMSA renal scan, and excretory urography (IVU).
Results |
Bleeding was controllable with superselective embolization in 38 patients (93%). Six of them developed early postembolization complications, in the form of perinephric hematoma in 4 and urinary leakage in 2 patients. At 3 months, serum creatinine levels increased in 3 of 9 patients with a solitary kidney, but none required renal replacement therapy. Long-term follow-up was completed for 30 patients for a mean period of 3.9 ± 2.3 years. We performed IVU for 27 patients. Among them, 2 renal units (7%) showed no dye excretion. DMSA scans showed homogeneous distribution of radiotracer with no evidence of photopenic areas in 6 renal units (20%). The mean percentage of DMSA uptake by the corresponding kidney improved from 25 ± 9% at the 3-month scans to 34 ± 11% at the last follow-up scans (P <0.001).
Conclusions |
The short-term deleterious effects of superselective renal embolization for post-PCNL renal vascular injuries were more pronounced in patients with a solitary kidney. However, the long-term follow-up showed functional and morphological improvements.
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Vol 71 - N° 3
P. 408-412 - mars 2008 Retour au numéroBienvenue sur EM-consulte, la référence des professionnels de santé.
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