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Radiologische Optionen nach partieller Nephrektomie

Radiological options after partial nephrectomy

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Die Onkologie Aims and scope

Zusammenfassung

Hintergrund

Die partielle Nephrektomie ist zum Standard der Behandlung von Patienten mit kleinen Nierenneoplasmen geworden. Das Verfahren ist jedoch mit einigen spezifischen Komplikationen verbunden, die eine minimal-invasive Behandlung erfordern.

Ziel

Im vorliegenden Artikel werden Diagnostik und interventionelle Therapieoptionen bei den postoperativen Komplikationen erörtert.

Material und Methoden

Hierzu erfolgte eine Literaturrecherche aus den aktuellen Leitlinien sowie über PubMed und der eigenen Literaturdatenbank.

Ergebnisse

Zu den am häufigsten durchgeführten Eingriffen gehören die Drainage von Flüssigkeit oder Abszessen, die Behandlung von Urinleckagen und die Embolisation von Blutungen. Bildgebende Verfahren sind für die Diagnose und Bewertung der postoperativen Komplikationen unerlässlich. Ultraschall- oder computertomographiegesteuerte Drainageverfahren sind bei der Behandlung von postoperativen Flüssigkeitsansammlungen oder Abszessen erfolgreich. Bei Patienten mit Urinleckage ist in vielen Fällen eine Harnableitung über eine perkutane Nephrostomie oder das Einsetzen eines Ureter-Stents wirksam. Bei persistierenden Leckagen können Emboliematerialien zur Abdichtung der Leckage eingesetzt werden. Bei Patienten mit postoperativen Blutungen weist die selektive Embolisation hohe Erfolgsraten bei minimalem Verlust des Nierenparenchyms auf.

Schlussfolgerung

Die interventionelle Radiologie bietet schnelle, sichere und effektive minimal-invasive Behandlungen für Komplikationen nach einer partiellen Nephrektomie.

Abstract

Background

Partial nephrectomy has become the standard of care in patients with small renal neoplasms. However, the procedure is associated with some typical complications that require a minimally invasive treatment.

Aims

The diagnosis and interventional treatment of complications seen after partial nephrectomy are elucidated.

Materials and methods

Current guidelines were reviewed, including a literature search in PubMed and our own literature database.

Results

Most commonly performed procedures include fluid or abscess drainage, treatment of urinary leakage, and bleeding embolization. Imaging is indispensable to diagnose and evaluate the extent of postoperative complications. Ultrasound- or computed tomography-guided drainage procedures are effective in the treatment of postoperative fluid collection or abscesses. In patients with urinary leakage, urinary diversion via percutaneous nephrostomy or ureteral stent placement is effective in many cases. In case of persistent leakage, embolic materials can be used to seal the leakage. In patients with postoperative bleeding, selective embolization has high success rates with minimal loss of renal parenchyma.

Conclusion

Interventional radiology offers quick, safe, and effective minimally invasive treatments for complications after partial nephrectomy.

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Literatur

  1. Benway BM, Bhayani SB, Rogers CG et al (2009) Robot assisted partial nephrectomy versus laparoscopic partial nephrectomy for renal tumors: a multi-institutional analysis of perioperative outcomes. J Urol 182:866–872

    Article  PubMed  Google Scholar 

  2. Breyer BN, Mcaninch JW, Elliott SP et al (2008) Minimally invasive endovascular techniques to treat acute renal hemorrhage. J Urol 179:2248–2252 (discussion 2253)

    Article  PubMed  Google Scholar 

  3. Chen CS, Ibrahim A, Shin JH et al (2021) Embolization of urinary tract fistulae using an AMPLATZER vascular plug and glue. J Vasc Interv Radiol 32:135–140

    Article  PubMed  Google Scholar 

  4. Choi MJ, Kim PH, Shin JH et al (2019) Angiographic management of percutaneous renal procedure-related bleeding: a single-center experience. Int J Urol 26:406–412

    Article  PubMed  Google Scholar 

  5. Erlich T, Abu-Ghanem Y, Ramon J et al (2017) Postoperative urinary leakage following partial nephrectomy for renal mass: risk factors and a proposed algorithm for the diagnosis and management. Scand J Surg 106:139–144

    Article  CAS  PubMed  Google Scholar 

  6. Geyik S, Yavuz K, Akgoz A et al (2007) The safety and efficacy of the angio-seal closure device in diagnostic and interventional neuroangiography setting: a single-center experience with 1,443 closures. Neuroradiology 49:739–746

    Article  PubMed  Google Scholar 

  7. Huber J, Pahernik S, Hallscheidt P et al (2010) Risk factors and clinical management of haemorrhage after open nephron-sparing surgery. BJU Int 106:1488–1493

    Article  PubMed  Google Scholar 

  8. Jain S, Nyirenda T, Yates J et al (2013) Incidence of renal artery pseudoaneurysm following open and minimally invasive partial nephrectomy: a systematic review and comparative analysis. J Urol 189:1643–1648

    Article  PubMed  Google Scholar 

  9. Kim SP, Thompson RH, Boorjian SA et al (2012) Comparative effectiveness for survival and renal function of partial and radical nephrectomy for localized renal tumors: a systematic review and meta-analysis. J Urol 188:51–57

    Article  PubMed  Google Scholar 

  10. Kwon LM, Hur S, Jeong CW et al (2021) Glue embolization of lymphopseudoaneurysm for chylous ascites after retroperitoneal surgery. Korean J Radiol 22:376–383

    Article  PubMed  Google Scholar 

  11. Meeks JJ, Zhao LC, Navai N et al (2008) Risk factors and management of urine leaks after partial nephrectomy. J Urol 180:2375–2378

    Article  PubMed  Google Scholar 

  12. Nouri YM, Chu HH, Shin JH et al (2019) Percutaneous obliteration of urinary leakage after partial nephrectomy using N‑butyl-cyanoacrylate obliteration of the urinoma with or without coil embolization of the fistula tract. J Vasc Interv Radiol 30:2002–2008

    Article  PubMed  Google Scholar 

  13. Öcal O, Puhr-Westerheide D, Mühlmann M et al (2021) iRESCUE—interventional embolization of renal artEries after SurgiCal or traUmatic injury with hEmorrhage. Eur J Radiol 136:109540

    Article  PubMed  Google Scholar 

  14. Piasecki P, Ząbkowski T, Brzozowski K et al (2018) The assessment of the risk of acute kidney injury in patients undergoing an urgent endovascular treatment due to severe renal bleeding. Cardiovasc Intervent Radiol 41:398–405

    Article  CAS  PubMed  Google Scholar 

  15. Potretzke AM, Knight BA, Zargar H et al (2016) Urinary fistula after robot-assisted partial nephrectomy: a multicentre analysis of 1 791 patients. BJU Int 117:131–137

    Article  PubMed  Google Scholar 

  16. Pradere B, Peyronnet B, Seisen T et al (2017) Impact of anticoagulant and antiplatelet drugs on perioperative outcomes of robotic-assisted partial nephrectomy. Urology 99:118–122

    Article  PubMed  Google Scholar 

  17. Sommer CM, Stampfl U, Bellemann N et al (2010) Patients with life-threatening arterial renal hemorrhage: CT angiography and catheter angiography with subsequent superselective embolization. Cardiovasc Intervent Radiol 33:498–508

    Article  CAS  PubMed  Google Scholar 

  18. Sureka SK, Madhavan K, Gaur P et al (2019) Failure of angiographic management in cases of postrenal intervention bleed: risk factors and management approach. Urology 125:40–45

    Article  PubMed  Google Scholar 

  19. Thompson RH, Boorjian SA, Lohse CM et al (2008) Radical nephrectomy for pT1a renal masses may be associated with decreased overall survival compared with partial nephrectomy. J Urol 179:468–471 (discussion 472–463)

    Article  PubMed  Google Scholar 

  20. Varkarakis IM, Rais-Bahrami S, Allaf ME et al (2005) Laparoscopic renal-adrenal surgery in patients on oral anticoagulant therapy. J Urol 174:1020–1023 (discussion 1023)

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Klinik und Poliklinik für Radiologie, LMU Klinikum München, Marchioninistr 15, 81377, München, Deutschland

    Osman Öcal &  Max Seidensticker

Authors
  1. Osman Öcal
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  2. Max Seidensticker
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Corresponding author

Correspondence to Max Seidensticker.

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Interessenkonflikt

O. Öcal gibt an, dass kein Interessenkonflikt besteht. M. Seidensticker erhält Vortragshonorare von Cook Medical, Boston Scientific, Balt.

Für diesen Beitrag wurden von den Autor/-innen keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

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Öcal, O., Seidensticker, M. Radiologische Optionen nach partieller Nephrektomie. Onkologie 29, 606–612 (2023). https://doi.org/10.1007/s00761-023-01310-3

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  • DOI: https://doi.org/10.1007/s00761-023-01310-3

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