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Case Reports
. 2023 Apr-Jun;15(2):238-241.
doi: 10.4103/ua.ua_23_23. Epub 2023 Apr 10.

Treatment of a hemorrhage secondary to nephrostomy tube placement for derivation of monstrous hydronephrosis in upper tract urothelial carcinoma

Iacopo Meneghetti  1 , Francesco Paolo Tarantino  2 , Luca Mosillo  1 , Chiara Catalano  1
Affiliations
Case Reports

Treatment of a hemorrhage secondary to nephrostomy tube placement for derivation of monstrous hydronephrosis in upper tract urothelial carcinoma

Iacopo Meneghetti et al. Urol Ann. 2023 Apr-Jun.

Abstract

A 85-year-old female patient underwent nephrostomy tube insertion for a huge hydronephrosis due to a papillary mass involving the right ureteral ostium diagnosed by at computed tomography scan. As soon as the nephrostomy tube was inserted, a pulsatile bleeding was found and a renal angiography was done. A massive bleeding from the main and unique right renal artery was found such as to require prompt endovascular embolization. A transurethral resection of the bladder was performed and the pathology report confirmed high-grade pTa transitional cell carcinoma. An open drainage was then placed to empty the contents of the pyelocalyceal system of the kidney. Once obtained the volumetric reduction of the abdominal mass the patient underwent the right nephroureterectomy.

Keywords: Hydroureteronephrosis; percutaneous nephrostomy; radical nephroureterectomy; transcatheter arterial embolization; upper tract urothelial carcinoma.

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Conflict of interest statement

There are no conflicts of interest.

Figures

Figure 1
Figure 1
CT scan performed upon patient arrival at A and E. We can point out the enormous pyelocaliceal dilatation of the right kidney and the markedly thinned renal cortex and poor concentration of iodized urine ipsilaterally. At the CT scan we also noticed marked compression on the liver with associated dilatation of the intra and extra hepatic bile ducts (maximum dilatation of about 12 mm of the bile duct). Front compression and a left pancreas with mild Wirsung duct ectasia. CT: Computed tomography
Figure 2
Figure 2
In the left image we note the diffusion of contrast medium from the right renal artery. It may also be noted that, due to hydronephrosis, the right renal artery is swung to the left. In the picture on the right, after the embolization, no more arterial leakage can be seen
Figure 3
Figure 3
We can noticed the presence of the lesion protruding from the right ureteral ostium during the resection of the bladder tumour
Figure 4
Figure 4
Specimen of the right kidney and the first portion of the ureter. The ureter was ligated and dissected to facilitate the safe removal of the mass and reduce the risk of tumor cell spillage into the abdomen
See this image and copyright information in PMC

References

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