Direct percutaneous embolization of renal pseudoaneurysm.

PURPOSE: To describe and evaluate a novel method of direct ultrasonography (US)-guided percutaneous embolization of renal pseudoaneurysm. PATIENTS AND METHODS: Fourteen patients with severe hematuria were included in this study from February 2005 to February 2006. They included five patients with penetrating renal trauma, two patients after renal biopsy, and seven patients after percutaneous nephrolithotripsy. Diagnostic duplex US of the pseudoaneurysm was performed. The size of the pseudoaneurysm and its neck were determined. A solution of Gelfoam particles was prepared in sterile saline and under US guidance, the tip of the needle was inserted into the aneurysm, and the solution with Gelfoam particles was injected slowly. During injection of Gelfoam, the pseudoaneurysm initially filled with an echogenic thrombus, thereby decreasing the color flow detected by US. The needle was removed when no flow in the pseudoaneurysm was detectable. The patient was kept for 30 minutes in the department and then discharged home. Follow-up by color Doppler US was performed every 2 weeks for 3 months and then every 3 months for 1 year. RESULTS: In 13 patients, bleeding was effectively controlled with direct embolization in a single session and did not need any further intervention, while one patient needed endovascular embolization because of recurrent severe hematuria after 24 hours. The amount of the injected Gelfoam particles (1-2 mm diameter) was 1 to 3 mL, according to the size of the pseudoaneurysm. No complication was observed secondary to the embolization procedure. Rebleeding did not occur in any patient during the follow-up period that ranged from 3 to 12 months. CONCLUSION: Direct US-guided percutaneous embolization is a new method for managing renal pseudoaneurysm. It avoids the side effects of contrast media, hazards of irradiation, and complications of angiographic catheterization. Moreover, it saves the risk of surgical interference to control bleeding either by partial or total nephrectomy, especially in patients with a solitary kidney. It is rapid, effective, feasible, and tissue preserving, and likely to reduce morbidity and mortality. Therefore, it is recommended as a first-line treatment of actively bleeding renal pseudoaneurysms.

Radiolucent renal stones in children: combined use of shock wave lithotripsy and dissolution therapy.

OBJECTIVES: To provide a noninvasive efficient modality for the treatment of radiolucent renal stones in children. Uric acid calculi comprise a significant proportion of urinary stones. METHODS: This study included 24 children (10 girls and 14 boys) with radiolucent renal stones. Of the 24 patients, 5 presented with bilateral renal stones, 8 with multiple stones, 4 with staghorn stones, and 7 with a solitary renal stone. Their age range was 2-12 years (mean 6.3 +/- 2.8). The stone size range was 12-65 mm in the largest diameter. All patients were treated with combined extracorporeal shock wave lithotripsy (ESWL) and medical therapy in the form of urinary alkalization using potassium sodium hydrogen citrate and allopurinol for the treatment of hyperuricosuria. Before ESWL, 3 patients had a percutaneous nephrostomy tube inserted and 2 patients had a ureteral stent placed to relieve obstruction. ESWL was performed with a Siemens Lithostar using either general anesthesia or intravenous sedation. The follow-up period after stone clearance was 12-36 months (mean 26 +/- 7.2). RESULTS: The stone-free rate of 100% was achieved in all 24 patients after 3 months of combined use of extracorporeal shock wave lithotripsy and dissolution therapy. CONCLUSIONS: Combined ESWL and dissolution therapy accelerated stone clearance and delayed stone recurrence. The use of ESWL and medical therapy as a combined modality is a safe and effective treatment of radiolucent renal stones in children.