Delayed hematuria secondary to bleeding papilla--potential complication of laparoscopic partial nephrectomy.
The complications of partial nephrectomy include hemorrhage, urinary leak, infection, formation of urinary fistula, and the development of renal insufficiency. We report a unique case of a patient who was found to have necrotic-appearing, bleeding, renal papillae after undergoing laparoscopic partial nephrectomy. A 66-year-old man was diagnosed with a left-sided, solid, enhancing, 2.5-cm, exophytic renal mass. Laparoscopic partial nephrectomy was performed, and the warm ischemia time was 31 minutes. He recovered uneventfully from surgery, but he started having episodes of gross hematuria approximately 5 months later. Computed tomography scan showed changes consistent with previous partial nephrectomy but no other abnormality. Ureterorenoscopy allowed us to identify several necrotic-appearing papillae in the same kidney that had undergone laparoscopic partial nephrectomy. A papilla in the lower pole was actively bleeding, and it was successfully obliterated using neodymium:yttrium-aluminum-garnet laser technology. Papillary necrosis can be a rare complication of laparoscopic or open partial nephrectomy. Additional study and close follow-up of patients who undergo partial nephrectomy is warranted.
Minimally Invasive Urology Institute, Cedars-Sinai Medical Center, Los Angeles, California 90048, USA. Gregory.Rosenblatt@cshs.org
Gregory S
GS
Rosenblatt
Tony Y
TY
Chen
Christopher S
CS
Ng
Gerhard J
GJ
Fuchs
D000368:Aged; D004621:Embolization, Therapeutic / Q000379:methods; D005500:Follow-Up Studies; D006417:Hematuria / Q000209:etiology* / Q000503:physiopathology / Q000628:therapy; D006801:Humans; D007679:Kidney Medulla / Q000503:physiopathology*; D007680:Kidney Neoplasms / Q000175:diagnosis / Q000601:surgery*; D010535:Laparoscopy / Q000009:adverse effects* / Q000379:methods; D008297:Male; D009392:Nephrectomy / Q000009:adverse effects / Q000379:methods*; D011183:Postoperative Complications / Q000175:diagnosis / Q000601:surgery; D018570:Risk Assessment; D013997:Time Factors; D016896:Treatment Outcome