THE ROLE OF INTERVENTIONAL RADIOLOGISTS IN THE TREATMENT OF COMPLICATIONS IN UROLOGIC PATIENTS

Abstract

Higher turnaround of urologic patients in the tertiary clinical center can lead to more accompanying complications, ranging from 1% to 55% for various procedures, with the incidence of vascular injuries varying from 0.43% up to 9.5%. In patients with impaired renal function, it is imperative to prevent the loss of normal kidney function and potential hemodialysis. Being minimally invasive, endovascular procedures such as renal artery embolization (RAE) can treat major and life-threatening complications, but good and prompt communication between urologists and interventional radiologist is necessary for fast and effective treatment. Absolute contraindications for RAE are the presence of acute infection and previously known anaphylactic reaction to the iodine contrast media, while previous mild or moderate allergic reactions to iodine contrast media are not contraindications for RAE. Currently used embolic agents can be divided into temporary and permanent embolization agents. While the temporary embolization agent available is a gelatin sponge that could be used as complementary material or stand-alone, for permanent embolization interventional radiologists use microparticles, microspheres, liquid embolic agents, coils, and microcoils. RAE procedures are considered to be safe with a low incidence of complications, with non-target embolization being the most serious one. Postembolization syndrome is considered to be the most common adverse effect and it involves around 90% of patients. The overall results show that RAE is a safe, minimally invasive procedure that can effectively treat significant complications caused by other urologic procedures, with the reported success rates of 87%-100%.

Keywords: Endovascular procedures; Iatrogenic kidney injuries; Renal artery embolization; Urologic procedures, complications.

Fig. 1

(a) Maximum intensity projection coronal reconstruction of the computed tomography (CT) scan showing active contrast blood extravasation (red arrow) in an elderly patient after mini percutaneous nephrolithotomy of the right kidney; blue arrow shows the proximal end of the JJ stent; (b) digital subtraction angiography in the same patient showing active contrast extravasation from one of the arcuate arteries of the right kidney middle third (red arrow); (c) magnified view of the extravasation after selective catheterization of the right kidney segmental branch; (d) control angiogram with super-selective catheterization of the interlobar arteries after embolization with the pushable coil (yellow arrow) showing successful embolization without active bleeding; (e) selective catheterization and control angiogram of the aberrant right renal artery showing there is no additional vascular injury present; (f) control postcontrast CT scan showing metal coil in place (yellow arrow) and initial regression in the size of retroperitoneal hematoma; the patient was stable after the procedure and was soon discharged from the hospital.