Early angiography improves postoperative clinical outcomes compared to delayed angiography among patients with vascular pathologies following partial nephrectomy.

Abstract

Purpose: This study aims to assess the evaluation, management, clinical outcomes and incidence of postoperative hematuria following partial nephrectomy (PNx) for renal tumors.

Methods: We retrospectively reviewed the medical charts of 936 adult patients who underwent PNx between 2008 and 2023. Patients presenting with hematuria during the first 6 months of surgery were included. Group 1, comprising patients who were treated with early angiography and selective embolization (n = 8), was compared to Group 2, patients who underwent imaging first (US or CTA), followed by angiography and selective embolization (n = 10, "delayed" angiography).

Results: 24 (2.6%) patients presented with hematuria, 18 (75%) required angiography-assisted intervention. Of those 18 patients, 17 (94.4%) were diagnosed with vascular pathologies; renal artery pseudoaneurysm (RAP) and arteriovenous fistula. Ultrasound (US) did not detect RAP in 33% of patients' initial evaluations (67% sensitivity). The median age was 67 years (IQR: 71.5-58.5 years), and the median time to hematuria was 11.5 days (IQR: 20.3- 7 days). The difference in the median interval time from presentation to embolization between Groups 1 and 2 was 20.2 h (CI 95%, p = 0.25). Group 1 had higher hemoglobin levels following therapy (p = 0.04), lower transfusion rates or antibiotic therapy (p = 0.02), shorter hospitalization stays (p = 0.03), and lower re-admission rates (p = 0.043) compared to Group 2.

Conclusion: RAP is ubiquitous among patients presenting with hematuria following PNx. With hematuria presentation, the use of US should be limited. For cases where selective embolization is considered, angiography is sufficient to identify vascular pathologies, guiding therapeutic intervention. Management by early angiographic intervention is associated with better clinical outcomes compared to delayed angiography following confirmatory imaging.