Imaging Pearls ❯ Kidney ❯ Complications of treatment
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- “Two main complications following nephrectomy requiring CT imaging is haemorrhage and urinary leakage. Post-operative haemorrhage may arise from an unsecured artery, or days to weeks later due to the rupture of a pseudoaneurysm of an intrarenal artery. The presence of a post-operative perinephric haematoma can be demonstrated by CT, ultrasound or MR imaging; however, the site of active haemorrhage is best demonstrated on a CT angiography (CTA), or ultimately, diagnostic angiography (DSA).”
Complications of renal interventions: a pictorial review of CT findings.
Lee, J.S.Z., Hall, J. & Sutherland, T.
Insights Imaging 12, 102 (2021) - A study of 1800 cases of open and laparoscopic partial nephrectomies found that approximately 5% of patients suffer significant blood loss requiring transfusion, with no significant difference in blood transfusion rates between the open or laparoscopic approach. Asymptomatic pseudoaneurysms have been detected on CT scans in approximately 15% of patients following partial nephrectomy in the early post-operative period. These usually spontaneously resolved, but a small number, approximately 1% in a case series, have required selective arterial embolisation .
Complications of renal interventions: a pictorial review of CT findings.
Lee, J.S.Z., Hall, J. & Sutherland, T.
Insights Imaging 12, 102 (2021) - Urinary leakage has been reported in approximately 1% of patients following open or laparoscopic partial nephrectomy [22, 23]. It can occur from intra-operative injury to the renal pelvis, ureters or urinary bladder. This may be clinically suspected following flank pain, renal dysfunction or drainage of urine from a surgical drain. A urinoma may be detected as a perinephric collection on an ultrasound, CT or MRI scan, which may cause ureteric or vascular compression. The site of urinary leakage is most commonly demonstrated as contrast extravasation from the renal tracts or collecting system on a CT urogram study, performed approximately 10–15 min after intravenous administration of contrast
Complications of renal interventions: a pictorial review of CT findings.
Lee, J.S.Z., Hall, J. & Sutherland, T.
Insights Imaging 12, 102 (2021) - “Intra-operative injuries to the adjacent structures can also occur post-renal surgery. Splenic injuries have been reported to occur in 4–13% of cases following left nephrectomy. Pancreatic, liver and gastric injuries have also been reported following renal surgeries. Bowel injury occurs in less than 1% of cases following laparoscopic surgery. Rarely, pneumothoraces can be caused by diaphragmatic injury during dissection of the upper pole of the kidney.”
Complications of renal interventions: a pictorial review of CT findings.
Lee, J.S.Z., Hall, J. & Sutherland, T.
Insights Imaging 12, 102 (2021)
- “Rhabdomyolysis, a clinical syndrome caused by damage to skeletal muscle and release of its breakdown products into the circulation, can be followed by acute kidney injury (AKI) as a severe complication. The belief that the AKI is triggered by myoglobin as the toxin responsible appears to be oversimplified. Better knowledge of the pathophysiology of rhabdomyolysis and following AKI could widen treatment options, leading to preservation of the kidney: the decision to initiate renal replacement therapy in clinical practice should not be made on the basis of the myoglobin or creatine phosphokinase serum concentrations.”
Acute kidney injury due to rhabdomyolysis and renal replacement therapy: a critical review.
Petejova N, Martinek A.
Crit Care. 2014 May 28;18(3):224 - “Rhabdomyolysis is a syndrome characterized by the breakdown of skeletal muscle and leakage of intracellular myocyte contents, such as creatine phosphokinase (CPK) and myoglobin, into the interstitial space and plasma resulting in acute kidney injury (AKI). Elevated CPK of at least 5 times the upper limit of normal is an important diagnostic marker of Rhabdomyolysis.”
Rhabdomyolysis-Associated Acute Kidney Injury With Normal Creatine Phosphokinase.
Kamal F, Snook L, Saikumar JH.
Am J Med Sci. 2018 Jan;355(1):84-87.
- “Complications from cryoablation are rare with bleeding from iceball fracture being the most common. In the vast majority of cases, intraoperative bleeding is usually easily controlled with hemostatic agents and direct pressure. When bleeding cannot be controlled in this manner, we most typi- cally perform a LPN. Advanced exposure of the hilum is important in cases where the surgeon suspects iceball fracture is likely. “
- “Complications from cryoablation are rare with bleeding from iceball fracture being the most common. In the vast majority of cases, intraoperative bleeding is usually easily controlled with hemostatic agents and direct pressure. When bleeding cannot be controlled in this manner, we most typically perform a LPN. Advanced exposure of the hilum is important in cases where the surgeon suspects iceball fracture is likely.”
Laparoscopic Ablation of Renal Neoplasms
Graversen JA et al.
ENDOUROLOGY Volume 25, Number 2, February 2011 Pp. 187–194 - “Excessive flank discomfort, prolonged ileus, and a decrease in hemoglobin level postoperatively are indications of post- operative hemorrhage. A CT scan of the abdomen and pelvis without contrast will identify a hematoma and thereby be diagnostic. In the event of postoperative hemorrhage, con- servative measures usually suffice. Patients remain on bed rest and are monitored with scheduled blood counts. Blood transfusion is rarely necessary.
Focal pain over a specific trocar site, low-grade fever, and leukopenia warrant prompt evaluation with a CT scan of the abdomen and pelvis with oral contrast to rule out bowel injury.”
Laparoscopic Ablation of Renal Neoplasms
Graversen JA et al.
ENDOUROLOGY Volume 25, Number 2, February 2011 Pp. 187–194 - CTA Evaluation of Renal Tumors for Laparoscopic Nephrectomy, Partial Nephrectomy or Ablation Therapy
- CTA mapping of the renal arterial anatomy can be used to select patients for the most appropriate management pathway
- In patients with planned Laparoscopic Nephrectomy CTA can be used to show vascular maps and help prevent surgical complications
- In planning partial nephrectomy CTA can help determine what patients are good candidates for partial nephrectomy based in great part on the vascular map
- In patients with planned ablation therapy the extent of ablation can be defined and the apporoach planned - “CTA can be used as part of the preoperative evaluation prior to laparoscopic nephrectomy to provide anatomical information about the presence of multiple renal arteries in the affected kidney of patients with RCC. This could help with planning the surgery and reducing surgical complications.”
Multiple renal arteries with renal cell carcinoma: preoperative evaluation using computed tomography angiography prior to laparoscopic nephrectomy.
Guan WH et al.
J Int Med Res. 2013 Oct;41(5):1705-15. - Pearls and Pitfalls
- The most common errors in the evaluation of the renal arteries are basic and revolve around poor protocol design and execution (poor data acquisition timing or patient motion)and the lack of routine MPR and 3D imaging
- Interpretation errors are more common in patients with complex vascular anatomy and patients with larger tumors or masses.
- GU Tract Complications: Chemotherapy
- Nephrotoxicity
- Tumor lysis syndrome- seen with acute leukemia or Burkitt’s lymphoma
- Hemorrhagic cystitis
- Neurogenic bladder
- Complications of oncologic therapy in the abdomen and pelvis: a review
Ganeshan DM et al.
Abdom Imaging (2013) 36:1-21 - GU Tract Complications: Radiation Therapy
- Radiation induced nephritis
- Radiation induced cystitis
- Complications of oncologic therapy in the abdomen and pelvis: a review
Ganeshan DM et al.
Abdom Imaging (2013) 36:1-21