title: Functional and morphological effects of postpercutaneous nephrolithotomy superselective renal angiographic embolization.
abstract: OBJECTIVE
  To evaluate the functional and morphological effects of postpercutaneous nephrolithotomy (PCNL) superselective renal angiographic embolization.
  
  
  METHODS
  Between January 1995 and March 2006, superselective renal angiography was needed to control severe bleeding after 41 of 4095 PCNL procedures (1%). We evaluated the short-term effects of embolization after 3 months with renal ultrasonography (RUS), dimercaptosuccinic acid (DMSA) renal scan, and estimation of serum creatinine. We evaluated long-term morphological and functional effects with RUS, DMSA renal scan, and excretory urography (IVU).
  
  
  RESULTS
  Bleeding was controllable with superselective embolization in 38 patients (93%). Six of them developed early postembolization complications, in the form of perinephric hematoma in 4 and urinary leakage in 2 patients. At 3 months, serum creatinine levels increased in 3 of 9 patients with a solitary kidney, but none required renal replacement therapy. Long-term follow-up was completed for 30 patients for a mean period of 3.9 +/- 2.3 years. We performed IVU for 27 patients. Among them, 2 renal units (7%) showed no dye excretion. DMSA scans showed homogeneous distribution of radiotracer with no evidence of photopenic areas in 6 renal units (20%). The mean percentage of DMSA uptake by the corresponding kidney improved from 25 +/- 9% at the 3-month scans to 34 +/- 11% at the last follow-up scans (P <0.001).
  
  
  CONCLUSIONS
  The short-term deleterious effects of superselective renal embolization for post-PCNL renal vascular injuries were more pronounced in patients with a solitary kidney. However, the long-term follow-up showed functional and morphological improvements.
authors.affiliation: Department of Urology, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt.
authors.forename: Ahmed R
authors.initials: AR
authors.lastname: el-Nahas
authors.forename: Ahmed A
authors.initials: AA
authors.lastname: Shokeir
authors.forename: Tarek
authors.initials: T
authors.lastname: Mohsen
authors.forename: Hossam
authors.initials: H
authors.lastname: Gad
authors.forename: Ahmed M
authors.initials: AM
authors.lastname: el-Assmy
authors.forename: Tarek
authors.initials: T
authors.lastname: el-Diasty
authors.forename: Hamdy A
authors.initials: HA
authors.lastname: el-Kappany
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004621:Embolization, Therapeutic; D005260:Female; D006801:Humans; D007668:Kidney / Q000098:blood supply* / Q000000981:diagnostic imaging*; D008297:Male; D008875:Middle Aged; D009403:Nephrostomy, Percutaneous / Q000009:adverse effects*; D019106:Postoperative Hemorrhage / Q000209:etiology* / Q000628:therapy*; D011859:Radiography; D012189:Retrospective Studies; D013997:Time Factors