Renal artery embolization: a first line treatment option for end-stage hydronephrosis.
Conventionally poorly functioning hydronephrotic kidneys have been removed if they are symptomatic. In our unit, patients are offered renal artery embolization as an alternative treatment option.


METHODS
Fifteen patients (11 male, 4 female) with a mean age of 32.9 yr (20-51 yrs) have undergone renal artery embolization for symptomatic hydronephrosis with poor function. Mean follow-up was 64.13 weeks (range 14-200). All patients had loin pain and hydronephrosis. Twelve patients had primary pelvi-ureteric junction obstruction (PUJO). Two patients had poorly functioning hydronephrotic kidneys secondary to chronic calculous obstruction. One patient had chronic pain in an obstructed but reasonably functioning kidney following a previous pyeloplasty for PUJO which demanded intervention. Mean split function on renography was 11% (range 0-46%). Selective renal artery embolization was carried out under antibiotic cover using a 7 Fr balloon occlusion catheter and absolute alcohol, steel coils, and polyvinyl alcohol particles.


RESULTS
Nine patients developed post-embolization syndrome of self-limiting pain and pyrexia with no evidence of sepsis. One patient required readmission with this condition. One patient developed a hematoma at the puncture site. Mean hospital stay was 2.3 days. Fourteen patients are happy with the result and are completely pain free. One patient has minor discomfort but is delighted with the result. Nine patients have had follow-up ultrasound confirming resolution of the hydronephrosis.


CONCLUSIONS
Renal artery embolization is an effective, safe, well-tolerated minimally invasive treatment option in end-stage hydronephrosis and we routinely offer it as an alternative to nephrectomy.
Mitra
Kakali
K
University Hospital of North Staffordshire NHS Trust, Newcastle under Lyme ST4 6QG, UK.
Prabhudesai
Vikramaditya
V
James
R Lester
RL
Jones
Robert W A
RW
French
Michael E
ME
Cowling
Mark
M
West
David J
DJ
D000328:Adult; D004621:Embolization, Therapeutic / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006869:Hydronephrosis / Q000000981:diagnostic imaging* / Q000628:therapy*; D007677:Kidney Function Tests; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D011859:Radiography; D011866:Radioisotope Renography / Q000379:methods; D012077:Renal Artery; D018570:Risk Assessment; D012494:Sampling Studies; D012720:Severity of Illness Index; D016896:Treatment Outcome; D014517:Ureteral Obstruction / Q000000981:diagnostic imaging / Q000628:therapy