sv 4v05 0002 Mp 361 Tuesday May 07 09:18 AM SV-Ab Image (v. 21, #6) 0002(1257) 4v08 Abdom Imaging 21:361–363 (1996) Abdominal I maging  Springer-Verlag New York Inc. 1996 Arterial embolization to control renal hemorrhage in patients with percutaneous nephrostomy J. Ueda, 1 T. Furukawa, 1 S. Takahashi, 1 O. Miyake, 2 H. Itatani, 2 Y. Araki 3 1 Department of Radiology, Sumitomo Hospital, 5-2-2 Nakanoshima, Kita-ku, Osaka 530, Japan 2 Department of Urology, Sumitomo Hospital, 5-2-2 Nakanoshima, Kita-ku, Osaka 530, Japan 3 Department of Radiology, Kinki University of Medicine, 3-7-7-2 Ohnohigashi Sayama-City, Osaka 530, Japan Received: 28 April 1995/Accepted: 2 June 1995 Abstract Two patients with renal hemorrhage treated by arterial embolization are reported. In one patient, one kidney was injured and the another had poor function. The other patient had one kidney. Although both patients had hematuria and underwent percutaneous nephros- tomy, the bleeding location was not detected angio- graphically. Repeated embolization and irrigations through a nephrostomy catheter following each embol- ization arrested the bleeding. Key words: Renal trauma — Embolization, Gelform — Nephrostomy catheter — Irrigation. Renal hemorrhage may have various causes including aneurysmal rupture, trauma, or neoplasm or it may be iatrogenic, from procedures such as nephrolithotomy, nephrostomy, or needle biopsy. Different modes of treatment of renal hemorrhage have been used, e.g., ne- phrectomy, branch ligation of the renal artery, and ar- terial embolization. The equipment for embolization has been rapidly improved, and this procedure now plays a prominent part in the treatment of renal hemorrhage. We report two cases, where the opposite kidney functioned poorly in one patient and the other patient had only one kidney, and there was no opportunity to perform ne- phrectomy or branch ligation. It was most important to preserve as much normal renal tissue as possible. In such conditions, superselective embolization, irrigation through the nephrostomy catheter immediately after- ward, and the use of a balloon catheter were advanta- geous. Correspondence to: J. Ueda Case Reports Case 1 A 40-year-old man with known cystinuria and bilateral renal stones complained of back pain and oliguria and was admitted to our hospital. Intravenous urography showed a hypertrophic right kidney and an atrophic left kidney. In addition, a nephrogram of the left kidney was very poor, and both kidneys had stones. A large stone was located at the right pelvico-ureteral junction and hindered urine flow. As a next step, a double-J catheter was placed between the right kidney and urinary bladder. The urine output was then restored, and the back pain disappeared. A few hours later, right back pain and oliguria again occurred. Percutaneous nephrostomy with a balloon catheter was therefore performed. Gross hematuria from the balloon catheter was observed for a few hours, and the catheter was finally occluded by a clot. The patient was submitted to pyelolithotomy, and another ne- phrostomy was done. The urine soon became yellow, and the urine output also recovered to the normal level. Three days later, gross he- maturia from the balloon catheter suddenly occurred. A tamponade catheter was inserted instead of the balloon catheter for percutaneous nephrostomy, and the collecting system was repeatedly irrigated with saline. Because the gross hematuria did not stop and the hemoglobin concentration was gradually decreasing in spite of transfusion, aor- tography was performed. The left kidney was enhanced a little, whereas the right renal arteriogram did not reveal any lesions causing gross hematuria, such as aneurysm, an arteriovenous fistula, or an arteriocalyceal fistula (Fig. 1A). Because it was speculated that small arteries near the balloon catheter were being damaged by the move- ment of the catheter, resulting in the observed hematuria, embolization with Gelform was used. The angiography catheter was introduced into the middle segmental branch supplying the area near the catheter. A few particles of Gelform were then injected, and the collecting system was irrigated to see whether there was any blood in the saline. To preserve as much normal tissue as possible, this was repeated several times until no blood was detected in the saline. Last of all, left renal arteriography was again performed, and it was noted that arteries sup- plying the middle part of the right kidney were occluded (Fig. 1B). Although hematuria from the tamponade catheter was subsequently detected once more, the condition of the patient improved day by day. One week later, the tamponade catheter was removed. The patient was followed up as an outpatient, and no hypertension was observed. Com-