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Lessons learned from clinical outcome and tumor features of patients underwent selective artery embolization due to postoperative bleeding following 2076 partial nephrectomies: propensity scoring matched study

 Doo Yong Chung  ;  Jong Soo Lee  ;  Almujalhem Ahmad  ;  Ki Don Chang  ;  Won Sik Ham  ;  Woong Kyu Han  ;  Chang Hee Hong  ;  Young Deuk Choi  ;  Koon Ho Rha 
 WORLD JOURNAL OF UROLOGY, Vol.38(5) : 1235-1242, 2020-05 
Journal Title
Issue Date
Ischemic time ; Partial nephrectomy ; Postoperative hemorrhage ; Selective arterial embolization ; Vascular complication
Purpose: To evaluate the clinical and tumor characteristics in patients undergoing selective artery embolization (SAE) for bleeding after partial nephrectomy (PN).

Methods: We retrospectively evaluated patients who underwent SAE from 2076 patients who underwent PN. The clinical and tumor characteristics of these patients were analyzed using entire data and propensity score matching (PSM). 76 patients who underwent PN (control, n = 38 patients; SAE, n = 38) were enrolled in PSM.

Results: SAE was performed in 41 patients who underwent open (19/1171), laparoscopic (4/60), and robot-assisted PN (18/845). The median period from PN to SAE was 12 days (interquartile range 8-24 day). The most common symptom of 31 (75.61%) patients was gross hematuria, followed by flank pain (3/41). Follow-up imaging revealed large pseudoaneurysm in 7 asymptomatic patients. The main reason for SAE on angiography was pseudoaneurysm (32/41), followed by arteriovenous fistula (5/41). Technical and clinical success was achieved in all patients. There was no statistical difference in the estimated glomerular filtration rate after 1 year, surgical methods, or baseline characteristics between the two groups. Conversely, there was statistically significant difference in ischemic time in the entire data and PSM. In the embolization group, renal masses showed statistically significant endophytic (p = 0.006) and posterior (p = 0.028) characteristics.

Conclusions: SAE is an effective method for controlling postoperative bleeding while preserving renal function after PN. And, we suggest more attentive postoperative surveillance about vascular complications in patients with longer ischemia time or renal masses with endophytic and posterior locations.
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1. College of Medicine (의과대학) > Dept. of Urology (비뇨의학교실) > 1. Journal Papers
Yonsei Authors
Rha, Koon Ho(나군호) ORCID logo https://orcid.org/0000-0001-8588-7584
Lee, Jong Soo(이종수) ORCID logo https://orcid.org/0000-0002-9984-1138
Choi, Young Deuk(최영득) ORCID logo https://orcid.org/0000-0002-8545-5797
Han, Woong Kyu(한웅규) ORCID logo https://orcid.org/0000-0002-2527-4046
Ham, Won Sik(함원식) ORCID logo https://orcid.org/0000-0003-2246-8838
Hong, Chang Hee(홍창희) ORCID logo https://orcid.org/0000-0002-0946-7702
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