Delayed haemorrhage after laparoscopic partial nephrectomy: frequency and angiographic findings

Area of Science:

• Urology
• Interventional Radiology
• Nephrology

Background:

• Delayed postoperative hemorrhage is a potential complication following laparoscopic partial nephrectomy (LPN).
• Identifying the incidence and characteristics of this complication is crucial for patient management.

Purpose of the Study:

• To determine the frequency of delayed postoperative hemorrhage requiring selective angioembolization (SAE) after LPN.
• To describe the clinical presentation and angiographic findings of delayed hemorrhage post-LPN.

Main Methods:

• Retrospective analysis of prospective data from 640 LPN procedures.
• Identification of patients with delayed hemorrhage (gross hematuria ≥ 7 days postoperatively) requiring SAE.
• Review of clinicopathological, preoperative, and perioperative factors; selective renal artery angiography and embolization for bleeding sites.

Main Results:

• SAE was required in 13 patients (2%) for delayed hemorrhage occurring 7-30 days post-surgery.
• Angiography revealed renal artery pseudoaneurysm in 10 patients and arteriovenous fistula in two.
• No significant changes in creatinine levels were observed post-embolization.

Conclusions:

• Clinically significant delayed postoperative bleeding after LPN is infrequent.
• Angiography accurately diagnoses renal artery pseudoaneurysm or arteriovenous fistula.
• SAE is a safe and effective treatment, preserving renal function.