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Lessons learned from clinical outcome and tumor features of patients underwent selective artery embolization due to postoperative bleeding following 2076 partial nephrectomies: propensity scoring matched study

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Abstract

Purpose

To evaluate the clinical and tumor characteristics in patients undergoing selective artery embolization (SAE) for bleeding after partial nephrectomy (PN).

Methods

We retrospectively evaluated patients who underwent SAE from 2076 patients who underwent PN. The clinical and tumor characteristics of these patients were analyzed using entire data and propensity score matching (PSM). 76 patients who underwent PN (control, n = 38 patients; SAE, n = 38) were enrolled in PSM.

Results

SAE was performed in 41 patients who underwent open (19/1171), laparoscopic (4/60), and robot-assisted PN (18/845). The median period from PN to SAE was 12 days (interquartile range 8–24 day). The most common symptom of 31 (75.61%) patients was gross hematuria, followed by flank pain (3/41). Follow-up imaging revealed large pseudoaneurysm in 7 asymptomatic patients. The main reason for SAE on angiography was pseudoaneurysm (32/41), followed by arteriovenous fistula (5/41). Technical and clinical success was achieved in all patients. There was no statistical difference in the estimated glomerular filtration rate after 1 year, surgical methods, or baseline characteristics between the two groups. Conversely, there was statistically significant difference in ischemic time in the entire data and PSM. In the embolization group, renal masses showed statistically significant endophytic (p = 0.006) and posterior (p = 0.028) characteristics.

Conclusions

SAE is an effective method for controlling postoperative bleeding while preserving renal function after PN. And, we suggest more attentive postoperative surveillance about vascular complications in patients with longer ischemia time or renal masses with endophytic and posterior locations.

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Authors and Affiliations

  1. Department of Urology, Inha University School of Medicine, Incheon, South Korea

    Doo Yong Chung

  2. Department of Urology, Urological Science Institute, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, South Korea

    Doo Yong Chung, Jong Soo Lee, Almujalhem Ahmad, Won Sik Ham, Woong Kyu Han, Chang Hee Hong, Young Deuk Choi & Koon Ho Rha

  3. Department of Urology, Yonsei University Wonju College of Medicine, Wonju, South Korea

    Ki don Chang

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  1. Doo Yong Chung
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  2. Jong Soo Lee
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  4. Ki don Chang
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  9. Koon Ho Rha
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Contributions

DYC (protocol/project development, manuscript writing, statistical analysis). JSL (data collection or management, manuscript writing). AA (data collection or management). KdC (data analysis). WSH (data analysis, data collection or management). WKH (manuscript editing). CHH (manuscript editing). YDC (manuscript editing). KHR (manuscript editing, protocol/project development).

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Correspondence to Koon Ho Rha.

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The authors declare that they have no conflict of interest.

Ethical statement

The current research was approved by the Severance Hospital institutional review board (protocol number 4-2018-1126).

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Chung, D.Y., Lee, J.S., Ahmad, A. et al. Lessons learned from clinical outcome and tumor features of patients underwent selective artery embolization due to postoperative bleeding following 2076 partial nephrectomies: propensity scoring matched study. World J Urol 38, 1235–1242 (2020). https://doi.org/10.1007/s00345-019-02883-8

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  • DOI: https://doi.org/10.1007/s00345-019-02883-8

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