Percutaneous transcatheter renal angioplasty: an endourological experience.

A series of 56 percutaneous transcatheter renal angioplasties, carried out in an endourological unit, is reviewed and compared with radiological series. The results were inferior for fibrosclerotic lesions (77 vs. 90%) and nonostial atherosclerosis (67.8 vs. 75%), but slightly superior for ostial lesions (33 vs. 20-30%) in the endourological series as compared with the radiological series. Conversely, morbidity was significantly inferior (8.9 vs. 18.6%). The endourological series compares well with the radiological series in the literature. Percutaneous transcatheter renal angioplasty should be considered a procedure belonging both to interventional radiology and to endourology. Owing to the technical difficulties and the complication rate, it should not be performed in outpatients and a surgical support team should be available in the event of a threatening renal complication.

Percutaneous temporary embolization of the internal pudendal arteries in idiopathic priapism: 2 additional cases.

We report 2 cases of successful treatment of priapism by transcatheter embolization of the internal pudendal arteries. Recovery of penile blood flow was confirmed by Doppler flowmetry and potency was preserved. Embolization with autologous clot is at least partially reversible and interventional angiography warrants consideration in the treatment of priapism.

Microsurgical spermaticoepigastric anastomosis for treatment of varicocele.

For varicocele correction, the occlusion of the internal spermatic vein is commonly performed, leaving the testis without its major pathway. Microsurgery offers the possibility to create a new venous drainage to the testis by anastomosing the internal spermatic vein with the inferior epigastric vein. Both stumps of the epigastric vein can be alternatively used, according to the different pathogenic mechanism of the varicocele. Eight patients with left varicocele were operated on using this new technique, with satisfactory results.

The role of venography and sclerotherapy in the management of varicocele.

Venography has recently been introduced in routine diagnostic evaluation of varicocele, and a pathogenetic classification based on venographic findings has been proposed. Transcatheter sclerotization of the internal spermatic vein completes the angiographic management of varicocele. After venographic classification of 56 cases, the patients with type-1 varicocele (reno-spermatic reflux) were treated by transcatheter sclerotization (group A, 25 patients) or high inguinal surgical ligation (group B, 15 patients). The results were quite similar, whereas the cost/benefit ratio was favorable to sclerotherapy.

Transcatheter embolization with autologous clot in the treatment of renal bleeding.

Six cases of renal bleeding which were successfully treated by transcatheter embolization with autologous clot are described and illustrated. The problems of clot lysis and consequent vessel recanalization are discussed both from an experimental and clinical point of view. It is concluded that clot embolization is suitable treatment for renal bleeding and, in selected cases, is preferable to open surgery.

Treatment of priapism by transcatheter embolization of internal pudendal arteries.

Priapism can be successfully treated by unilateral or bilateral percutaneous transcatheter occlusion of the internal pudendal arteries. Occlusion should be reversible in order to avoid impotence. Embolization with autologous clot satisfies this requirement because of the clot lysis and consequent vessel recanalization. Three cases are extensively described which demonstrate the feasibility of the method and the ability to preserve sexual potency. The rationale for using interventional angiography in priapism is also discussed.

Usefulness of preoperative transcatheter embolization in kidney tumors.

In recent years preoperative transcatheter embolization has been used widely in the management of kidney tumors. However, the effective clinical usefulness of this method has not yet been proved. Forty cases of kidney tumors treated by preoperative embolization and radical nephrectomy are reviewed and compared with a homogeneous group of patients who did not undergo preoperative embolization. Intraoperative blood loss, postoperative complication, and survival rate were statistically evaluated according to tumor stage. Advantages and disadvantages of preoperative transcatheter embolization of kidney tumors are reviewed.

[Brisk postoperative bleeding in a solitary kidney successfully treated by temporary clot embolization (author's transl)]. / Hémorragie rénale massive post-opératoire traitée avec succès par embolisation percutanée "temporaire".

The so called temporary embolization by percutaneous injection of autologous clot can be envisaged as the method of choice in selected cases of massive renal bleeding. The goals of this technique are to occlude the bleeding vessels until a satisfactory hemostasis is achieved and to preserve as far as possible the renal parenchyma by adopting a completely reabsorbable embolic material as the autologous clot. After a review of the literature a case is presented where a temporary embolization was performed in a young woman with brisk postoperative bleeding in a solitary kidney. The procedure was successful and the renal function was not impaired.

Idiopathic priapism successfully treated by unilateral embolization of internal pudendal artery.

A case is described of idiopathic priapism successfully treated by transcatheter embolization of the left internal pudendal artery with autologous clots. The rationale for the use of this new approach in the treatment of priapism is discussed briefly.