Magnetic resonance imaging characteristics and changes in hemostatic agents after partial nephrectomy

  • Erdem KisaEmail author
  • Hilal Sahin
  • Ozgür Cakmak
  • Cem Yucel
  • Gokhan Koc
  • Zafer Kozacioglu
  • Yusuf Ozlem Ilbey
Urology - Original Paper



To evaluate the characteristics of images generated by magnetic resonance imaging (MRI) and changes in the mass-like lesion (MLL) during the follow-up of patients who underwent partial nephrectomy (PN) with the intra-operative use of hemostatic agents (HAs).


The records of patients who had undergone PN in our clinic due to renal mass between January 2013 and August 2018 were retrospectively reviewed. Our study included 47 patients who were administered one or more HAs during the PN and who received diffusion and dynamic MRI at the post-operative 2nd/4th Queryand 12th month.


MLL is defined as T2 heterogeneous, intermediate-signal intensity bolster-related mass with a pseudocapsule in the renal parenchymal defect. When we looked at the morphological changes of MLL, the mean largest axial dimensions of masses were 27.3 (range 12.2–44.7) mm in the first follow-up period (2nd/4th months) and 21.2 (range 11–44.7) mm in the 12th month follow-up period. The average change in size of MLL was − 0.66 mm/month. We did not see any significant relationship between observation of MLL in the post-operative follow-up MRI images and the use of HAs such as Surgicel®, Spongostan®, and autologous fatty tissue as well as the amount of the agents used in PN operations (p = 0.405, p = 0.159, respectively).


The distinction of MLL causing bolster-related mass and granulomatosis tissue from relapse/recurrence can be made based on the change in mass size observed in the MR images and image characteristics.


Partial nephrectomy Renal tumors Hemostatic agents Magnetic resonance imaging 


Compliance with ethical standards

Conflict of interest

There is no conflict of interest. Author Erdem KISA declares that he has no conflict of interest. Author Hilal Sahin declares that he has no conflict of interest. Author Ozgür CAKMAK declares that he has no conflict of interest. Author Cem YÜCEL declares that he has no conflict of interest. Author Gokhan KOC declares that he has no conflict of interest. Author Zafer KOZACIOGLU declares that he has no conflict of interest. Author Yusuf Ozlem ILBEY declares that he has no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Local ethic committee; Date 13/02/2019 No: 24.

Informed consent

Informed consent was obtained from all individual participants included in the study.


  1. 1.
    Ljungberg B, Bensalah K, Canfield S et al (2015) EAU guidelines on renal cell carcinoma: 2014 update. Eur Urol 67:913CrossRefGoogle Scholar
  2. 2.
    Van Poppel H, Kilen K, Baert L (2001) Incidental renal cell carcinoma and nephron sparing surgery. Curr Opin Urol 11:281CrossRefGoogle Scholar
  3. 3.
    Carrion DM, Y Gregorio SA, Rivas JG et al (2017) The role of hemostatic agents in preventing complications in laparoscopic partial nephrectomy. Cent Eur J Urol 70(4):362–367Google Scholar
  4. 4.
    Breda A, Stepanian SV, Lam JS et al (2007) Use of haemostatic agents and glues during laparoscopic partial nephrectomy: a multi-institutional survey from the United States and Europe of 1347 cases. Eur Urol 52:798–803CrossRefGoogle Scholar
  5. 5.
    Lang H, Mouracade P, Gimel P et al (2014) National prospective study on the use of local haemostatic agents during partial nephrectomy. BJU Int 113:E56–E61CrossRefGoogle Scholar
  6. 6.
    Emilia M, Luca S, Francesca B et al (2011) Topical hemostatic agents in surgical practice. Transfus Apher Sci 45(3):305–311CrossRefGoogle Scholar
  7. 7.
    Galanakis I, Vasdev N, Soomro N (2011) A review of current hemostatic agents and tissue sealants used in laparoscopic partial nephrectomy. Rev Urol 13(3):131–138Google Scholar
  8. 8.
    Paka B, Bossemeyer R, Tourojman M et al (2017) Holding strength of a Hem-o-lok/Lapra-Ty clip combination on sutures used during partial nephrectomy. Urology 107:138–143CrossRefGoogle Scholar
  9. 9.
    Thompson T, Ng CF, Tolley D (2003) Renal parenchymal hemostatic aids: glues and things. Curr Opin Urol 13:209–214CrossRefGoogle Scholar
  10. 10.
    Williamson TJ, Pearson JR, Ischia J et al (2016) Guideline of guidelines: follow-up after nephrectomy for renal cell carcinoma. BJU Int. 117(4):555–562CrossRefGoogle Scholar
  11. 11.
    Israel GM, Hecht E, Bosniak MA (2006) CT and MR imaging of complications of partial nephrectomy. Radiographics 26(5):1419–1429CrossRefGoogle Scholar
  12. 12.
    Kim TS, Park JG, Kang H et al (2016) Computed tomography imaging features and changes in hemostatic agents after laparoscopic partial nephrectomy. J Endourol 30(9):950–957CrossRefGoogle Scholar
  13. 13.
    Lee MS, Oh YT, Han WK et al (2007) CT findings after nephron-sparing surgery of renal tumors. AJR Am J Roentgenol 189(5):W264–W271CrossRefGoogle Scholar
  14. 14.
    Young ST, Paulson EK, McCann RL et al (1993) Appearance of oxidized cellulose (Surgicel) on postoperative CT scans: similarity to postoperative abscess. AJR 160:275–277CrossRefGoogle Scholar
  15. 15.
    Pai D, Willatt JM, Korobkin M et al (2010) CT appearances following laparoscopic partial nephrectomy for renal cell carcinoma using a rolled cellulose bolster. Cancer Imaging 10:161–168CrossRefGoogle Scholar
  16. 16.
    Thompson RH, Boorjian SA, Lohse CM et al (2008) Radical nephrectomy for pT1a renal masses may be associated with decreased overall survival compared with partial nephrectomy. J Urol 179:468CrossRefGoogle Scholar
  17. 17.
    Antonelli A, Minervini A, Mari A et al (2015) TriMatch comparison of the efficacy of FloSeal versus TachoSil versus no hemostatic agents for partial nephrectomy: results from a large multicenter dataset. Int J Urol 22(1):47–52CrossRefGoogle Scholar
  18. 18.
    Abu-Ghanem Y, Dotan Z, Kaver I et al (2016) The use of haemostatic agents does not impact the rate of hemorrhagic complications in patients undergoing partial nephrectomy for renal masses. Sci Rep 30(6):32376CrossRefGoogle Scholar
  19. 19.
    Pierce A, Wilson D, Wiebkin O (1987) Surgicel: macrophage processing of the fibrous component. Int J Oral Maxillofac Surg 16:338–345CrossRefGoogle Scholar
  20. 20.
    Bailey OT, Ingraham FD (1944) Chemical, clinical, and immunological studies on the products of human plasma fractionation. XXI. The use of fibrin foam as a hemostatic agent in neurosurgery: clinical and pathological studies. J Clin Investig 23(4):591–596CrossRefGoogle Scholar

Copyright information

© Springer Nature B.V. 2019

Authors and Affiliations

  1. 1.Department of UrologyTepecik Training and Research HospitalIzmirTurkey
  2. 2.Department of RadiologyTepecik Training and Research HospitalIzmirTurkey

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