title: Renal Embolization and Urothelial Sclerotherapy for Recurrent Obstructive Urosepsis and Intractable Haematuria from Upper Tract Urothelial Carcinoma.
abstract: Management of intractable haematuria and obstructive urosepsis from upper tract urothelial carcinoma can be problematic in patients not suitable for surgery, chemotherapy or radiotherapy. Interventional radiology techniques provide alternative approaches in this setting, such as complete kidney embolization to cease urine output, percutaneous nephrostomy, antegrade injection of sclerotherapy agents and sterilisation of the upper collecting system. Related approaches have been successfully employed to sclerose renal cysts, lymphoceles, chyluria and intractable lower tract haemorrhage. No reports of percutaneous, antegrade sclerotherapy in the upper urinary tract have previously been published. We present a case of recurrent haematuria and obstructive urosepsis caused by invasive upper tract urothelial carcinoma in a non-operative patient, which was treated with renal embolisation and percutaneous upper tract urothelial sclerotherapy.
authors.affiliation: Department of Interventional Radiology, St Vincent's Hospital, Melbourne, Australia. nibrown@cantab.net.
authors.forename: Nicholas
authors.initials: N
authors.lastname: Brown
authors.affiliation: Department of Urology, St Vincent's Hospital, Melbourne, Australia.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Olayos
authors.affiliation: Department of Urology, St Vincent's Hospital, Melbourne, Australia.
authors.forename: Sandra
authors.initials: S
authors.lastname: Elmer
authors.affiliation: Department of Urology, St Vincent's Hospital, Melbourne, Australia.
authors.forename: Lih-Ming
authors.initials: LM
authors.lastname: Wong
authors.affiliation: Department of Interventional Radiology, St Vincent's Hospital, Melbourne, Australia.
authors.forename: Duncan M
authors.initials: DM
authors.lastname: Brooks
authors.affiliation: Department of Interventional Radiology, St Vincent's Hospital, Melbourne, Australia.
authors.forename: Ashu
authors.initials: A
authors.lastname: Jhamb
mesh_terms: D000369:Aged, 80 and over; D002295:Carcinoma, Transitional Cell / Q000150:complications*; D004621:Embolization, Therapeutic / Q000379:methods*; D000431:Ethanol / Q000008:administration & dosage; D006417:Hematuria / Q000209:etiology / Q000628:therapy*; D006801:Humans; D007668:Kidney / Q000187:drug effects; D008297:Male; D010166:Palliative Care; D019919:Prosthesis Implantation; D012008:Recurrence; D012077:Renal Artery / Q000187:drug effects; D015911:Sclerotherapy / Q000379:methods*; D018805:Sepsis / Q000209:etiology / Q000628:therapy; D015607:Stents; D014517:Ureteral Obstruction / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy*; D014552:Urinary Tract Infections / Q000209:etiology / Q000628:therapy*; D014571:Urologic Neoplasms / Q000150:complications* / Q000000981:diagnostic imaging
chemical_list: D000431:Ethanol
keywords: Embolisation; Haematuria; Sclerotherapy; Urosepsis; Urothelium