Percutaneous Resection of Renal Transitional Carcinoma: Venous Injury and Its Conservative Management

Abstract

An interesting observation encountered at percutaneous resection of a renal transitional cell carcinoma and its conservative management is described. During resection of the tumour sudden heavy haematuria was encountered. Nephroscopic inspection revealed the blood to be coming from behind a loop-generated flap, the raising of which allowed entry of the endoscope into a sizeable vein and thence upwards into the renal vein and inferior vena cava (IVC). On table nephrostogram confirmed contrast outlining the renal vein and IVC. Placement and clamping of a nephrostomy tube was followed by stabilization of the patient and the bleeding stopped. The urine became clear within 24 h. Later on repeat nephrostogram showed an intact pelvicalyceal system with an acceptable tumour clearance. This case highlights the importance of a trial of conservative management in the treatment of bleeding complications during nephroscopy.

Percutaneous silicon catheter insertion into the IVC, following percutaneous nephrostomy (PCN) exchange

“…6 The advancement of the endoscope resulted in padding through a large vein, into the renal vein to the IVC. The case was managed conservatively by inserting a nephrostomy tube and clamping it, with no later major complication.…”

Endourologic Management of Upper Tract Transitional Cell Carcinoma following Cystectomy and Urinary Diversion

“…This is of particular advantage in patients with large (>1 cm) tumor burden, solitary kidney, poor renal function, or significant comorbidites that would preclude open or laparoscopic nephroureterectomy. Bleeding due to the vascularity of the kidney and proximity to the hilum [46] and antegrade tract seeding [47] are complications of percutaneous treatment that despite infrequently being reported are still of significant concern. In comparison to the retrograde approach, percutaneous resection of upper tract TCC is more invasive and is associated with higher complication rates.…”

Percutaneous Management of Upper-Tract Transitional Cell Carcinoma

“…Loop monopolar diathermy has resulted in renal-vein injury caused by resection of a fold inside the renal pelvis overlying the vein. 24 Rollerball electrode use or electrovaporization causes vaporization of the tumor and may avoid deep resection and its subsequent bleeding, making it ideal for flat lesions. 18,20 Loop resection or laser ablation is recommended for large bulky tumors.…”